JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Nicholas G. Smedira
Cornelius M. Dyke
Michael Jurmann
Devinder S. Bhatia
Harry L. McCarthy, II
Bruce D. Spiess
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Smedira, N. G.
Right arrow Articles by Aronson, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Smedira, N. G.
Right arrow Articles by Aronson, S.
Related Collections
Right arrow Cardiac - other
Right arrowRelated Articles

J Thorac Cardiovasc Surg 2006;131:686-692
© 2006 The American Association for Thoracic Surgery

Evolving Technology

Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: The results of the EVOLUTION-OFF study

Nicholas G. Smedira, MD a , * , Cornelius M. Dyke, MD d , Andreas Koster, MD c , Michael Jurmann, MD c , Devinder S. Bhatia, MD e , Tingfei Hu, MS a , Harry L. McCarthy, II, BS, CCP b , A. Michael Lincoff, MD a , Bruce D. Spiess, MD b , Solomon Aronson, MD f

a Cleveland Clinic Foundation, Cleveland, Ohio
b VCURES/Virginia Commonwealth University Medical Center, Richmond, Va
c Deutsches Herzzentrum, Berlin, Germany
d Gaston Memorial Hospital, Gastonia, NC
e Houston North West Medical Center, Houston, Tex
f Duke University Medical Center, Durham, NC

Received for publication July 7, 2005; revisions received October 10, 2005; accepted for publication October 20, 2005.

* Address for reprints: Nicholas G. Smedira, MD, Cleveland Clinic Foundation, 9500 Euclid Ave/Desk F24, Cleveland, OH 44195. (Email: smedirn{at}ccf.org).

OBJECTIVES: Unfractionated heparin has many shortcomings, including indirect and partial inhibition of thrombin, antibody formation, and platelet activation. Bivalirudin, a short-acting direct thrombin inhibitor, avoids these limitations and has superior outcomes during percutaneous revascularization. This trial was performed to evaluate the safety and efficacy of bivalirudin in off-pump coronary artery bypass grafting.

METHODS: An open-label, multicenter randomized trial compared heparin with protamine reversal to bivalirudin in patients undergoing off-pump coronary artery bypass. The primary objective was safety as demonstrated by similar rates of procedural success defined as freedom from a composite of death, myocardial infarction, stroke, and repeat revascularization. Twenty-one institutions randomized 105 patients to receive bivalirudin and 52 patients to receive heparin.

RESULTS: The mean age was 65 years for both groups. The bivalirudin group had more grafts: 3.0 ± 1 versus 2.5 ± 1. Procedural success rates at 30 days were identical in bivalirudin- and heparin-treated patients (93%). Operative times, total blood loss, reoperations for bleeding, and major adverse events were not significantly different. Strokes were more frequent in the heparin group: 5.5% versus 0; P = .05. Mortality was 2% in each group. Repeat revascularization was required in 3% of bivalirudin- and 2% of the heparin-treated patients.

CONCLUSIONS: For patients undergoing off-pump coronary artery bypass grafting, bivalirudin was an effective anticoagulant, without excessive bleeding and with a safety profile similar to that of heparin. Further trials are warranted to assess whether anticoagulation with bivalirudin improves clinical outcomes.

Abbreviations and Acronyms ACT = activated clotting time; CABG = coronary artery bypass grafting; EVOLUTION = EValuation of Patients during coronary artery bypass graft Operations: Linking UTilization of bivalirudin to Improved Outcomes and New anticoagulant strategies; HIT = heparin-induced thrombocytopenia; MI = myocardial infarction; OPCAB = off-pump coronary artery bypass grafting; REPLACE = Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events; TIMI = thrombolysis in myocardial infarction


Related Articles

Anticoagulation for cardiopulmonary bypass: Is a replacement for heparin on the horizon?
Theodore E. Warkentin
J. Thorac. Cardiovasc. Surg. 2006 131: 515-516. [Extract] [Full Text] [PDF]

A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: The EVOLUTION-ON study
Cornelius M. Dyke, Nicholas G. Smedira, Andreas Koster, Solomon Aronson, Harry L. McCarthy, II, Ronald Kirshner, A. Michael Lincoff, and Bruce D. Spiess
J. Thorac. Cardiovasc. Surg. 2006 131: 533-539. [Abstract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 ChestHome page
L.-A. Linkins, A. L. Dans, L. K. Moores, R. Bona, B. L. Davidson, S. Schulman, and M. Crowther
Treatment and Prevention of Heparin-Induced Thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Chest, February 1, 2012; 141(2_suppl): e495S - e530S.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
R. M. Sniecinski and W. L. Chandler
Review Articles: Activation of the Hemostatic System During Cardiopulmonary Bypass
Anesth. Analg., December 1, 2011; 113(6): 1319 - 1333.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
C. Brown, B. Joshi, N. Faraday, A. Shah, D. Yuh, J. J. Rade, and C. W. Hogue
Review Article: Emergency Cardiac Surgery in Patients with Acute Coronary Syndromes: A Review of the Evidence and Perioperative Implications of Medical and Mechanical Therapeutics
Anesth. Analg., April 1, 2011; 112(4): 777 - 799.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
R. M. Sniecinski, M. J. Hursting, M. J. Paidas, and J. H. Levy
Review Article: Etiology and Assessment of Hypercoagulability with Lessons from Heparin-Induced Thrombocytopenia
Anesth. Analg., January 1, 2011; 112(1): 46 - 58.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Koster, U. Rosendahl, E. von Hodenberg, and J. Ennker
Management of Protamine Allergy With Bivalirudin During Coronary Artery Revascularization
Ann. Thorac. Surg., July 1, 2010; 90(1): 276 - 277.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
I. J. Welsby, J. Um, C. A. Milano, T. L. Ortel, and G. Arepally
Plasmapheresis and Heparin Reexposure as a Management Strategy for Cardiac Surgical Patients with Heparin-Induced Thrombocytopenia
Anesth. Analg., January 1, 2010; 110(1): 30 - 35.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
A Koster, S Buz, T Krabatsch, R Yeter, and R Hetzer
Bivalirudin anticoagulation during cardiac surgery: a single-center experience in 141 patients
Perfusion, January 1, 2009; 24(1): 7 - 11.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
B. Kiaii, R. S. McClure, P. Stewart, R. Rayman, S. A. Swinamer, Y. Suematsu, S. Fox, J. Higgins, C. Albion, W. J. Kostuk, et al.
Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up
J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 702 - 708.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
Q. A Czosnowski, S. W Finks, and K. C Rogers
Bivalirudin for Patients with Heparin-Induced Thrombocytopenia Undergoing Cardiovascular Surgery
Ann. Pharmacother., September 1, 2008; 42(9): 1304 - 1309.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff
Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 340S - 380S.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
A. F. Merry
Focus on Thrombin: Alternative Anticoagulants
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 256 - 260.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. M. Dyke, G. Aldea, A. Koster, N. Smedira, E. Avery, S. Aronson, B. D. Spiess, and A. M. Lincoff
Off-Pump Coronary Artery Bypass With Bivalirudin for Patients With Heparin-Induced Thrombocytopenia or Antiplatelet Factor Four/Heparin Antibodies
Ann. Thorac. Surg., September 1, 2007; 84(3): 836 - 839.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. N. Schroder, M. A. Daneshmand, N. R. Villamizar, R. P. Petersen, L. J. Blue, I. J. Welsby, A. J. Lodge, T. L. Ortel, J. G. Rogers, and C. A. Milano
Heparin-Induced Thrombocytopenia in Left Ventricular Assist Device Bridge-to-Transplant Patients
Ann. Thorac. Surg., September 1, 2007; 84(3): 841 - 846.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. H. Levy, K. A. Tanaka, and M. J. Hursting
Reducing Thrombotic Complications in the Perioperative Setting: An Update on Heparin-Induced Thrombocytopenia
Anesth. Analg., September 1, 2007; 105(3): 570 - 582.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Koster, Y. Weng, W. Bottcher, T. Gromann, H. Kuppe, and R. Hetzer
Successful Use of Bivalirudin as Anticoagulant for ECMO in a Patient With Acute HIT
Ann. Thorac. Surg., May 1, 2007; 83(5): 1865 - 1867.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
F. Pappalardo, A. Franco, G. Crescenzi G, A. Poli, A. Zangrillo, and A. Koster
Successful use of bivalirudin for cardiopulmonary bypass in a patient with heparin allergy
Perfusion, January 1, 2007; 22(1): 67 - 69.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.