Risk for Radial Artery Thrombosis During Transradial Coronary Intervention With Bivalirudin vs UFH

There was a greater risk for radial artery thrombosis (RAT) during transradial coronary intervention (TRI) associated with the use of bivalirudin vs unfractionated heparin (UFH), according to study results published in the Journal of Interventional Cardiology.

A total of 211 patients who underwent TRI by radial artery optical coherence tomography between 2017 and 2019 at the Capital Medical University in China were recruited. Patients were given UFH (n=144; 70-100 IU/kg bolus followed by additional doses at 200-300 second intervals) or bivalirudin (n=67; 0.75 mg/kg bolus followed by 1.75 mg/kg/h) prior to TRI. All participants also received aspirin (300 mg) and ticagrelor (180 mg) or clopidogrel (300-600 mg) before the procedure.

At baseline, patients receiving bivalirudin vs UFH differed significantly in: age (60.4±12.6 vs 54.9±11.9 years, respectively; P =.003), comorbid hypertension (82.1% vs 71.5%, respectively; P =.012), tirofiban use (35.8% vs 21.5%, respectively; P =.028), procedure type (coronary angiography: 1.5% vs 10.4%, respectively; percutaneous coronary intervention: 98.5% vs 89.6%, respectively; P =.023), and number of guiding catheters (1.26±0.469 vs 1.15±0.557, respectively; P =.022).

After propensity score matching, 47 and 75 patients were included in the bivalirudin and UFH groups, respectively for the final analysis.

Thrombus was found to occur more frequently among participants administered bivalirudin vs UFH (42.3% vs 13.9%, respectively; P <.001). This difference in thrombus between patients who received bivalirudin vs UFH was driven by differences in proximal (34.6% vs 2.5%, respectively; P <.001), not middle (13.5% vs 6.3%, respectively; P =.218) or distal (7.7% vs 6.3%, respectively; P =.740) thrombus.

Participants who had proximal thrombus events and were treated with bivalirudin vs UFH had greater: total thrombus volume (12.007 vs 0.085 mm³, respectively; P <.001), total thrombus score (421 vs 9 respectively; P <.001), and thrombus burden (1.37% vs 0.81% respectively; P <.001).

Risk for RAT among patients given bivalirudin vs UFH was 3.872 times greater in the entire cohort (95% CI, 2.006-8.354; P <.001), and 3.782 times higher in the propensity matched cohort (95% CI, 1.546-9.253; P =.004).

The following parameters were found to be independent predictors of RAT: anticoagulant (odds ratio [OR], 3.782; 95% CI, 1.546-9.253; P =.004), intima injury (OR, 2.759; 95% CI, 1.132-6.725; P =.026), procedural time (OR, 1.026; 95% CI, 1.003-1.049; P =.026), and sheath diameter/radial artery diameter ratio (OR, 2.947; 95% CI, 1.122-7.741; P =.028).

Following the TRI procedure, 4.3% of patients had complications detected by tomography and confirmed by ultrasound. The risk for complications was comparable in patients receiving bivalirudin vs UFH (2.8% vs 7.7%; P =.143).

This study was limited by the lack of long-term data.

“The results highlighted that UFH may be preferable over bivalirudin to prevent RAT in the local radial artery access,” concluded the study authors.

Reference

Liu Z, Wang G, Niu D, et al. Bivalirudin vs. heparin on radial artery thrombosis during transradial coronary intervention: An optical coherence tomography study. J Interv Cardiol. 2020;2020:7905021. doi:10.1155/2020/7905021