Fopcab Surgery

Merry et al. (2004) compared bivalirudin to UFH for OPCAB surgery in a semi-open label (surgeon-blinded), prospective study of 100 patients (half receiving bivalirudin). The primary endpoint was 12-h blood loss, and secondary endpoints were ischemic complications and coronary artery patency at 12 wk. No deaths were reported. The ACT took longer to return to normal after stopping bivalirudin, when compared to the UFH group (which received protamine reversal). Total blood loss was similar in both groups, however. An intriguing (and potentially important) finding was that graft patency was improved in the patients receiving bivalirudin.

More recently, results from the EVOLUTION-OFF study for OPCAB were published. Smedira et al. (2006) reported on 105 patients randomized to receive bivalirudin and 52 patients who were given UFH. Procedural success rates at 30 days and mortality were identical in both groups, while stroke rates were numerically more frequent in the UFH group (5.5% vs. 0%), and repeat revascular-ization occurred more often in the bivalirudin group (3% vs. 2%). The authors concluded that while data interpretation should be cautious given the small numbers, this study provides further evidence that bivalirudin is a safe and effective alternative to UFH plus protamine for OPCAB surgery.

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