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J Thorac Cardiovasc Surg 2003;126:2108-2109
© 2003 The American Association for Thoracic Surgery

Letter to the editor

Bivalirudin as alternative to both danaparoid and heparin in off-pump coronary artery bypass grafting

Frank A. Baciewicz, Jr, MDa

a Cardiothoracic Surgery, Wayne State University, School of Medicine, Detroit, MI 48201, USA

To the Editor:

I enjoyed the recent article "Heparin Versus Danaparoid in Off-Pump Coronary Bypass Grafting: Results of a Prospective Randomized Clinical Trial" by Carrier and colleagues.1 I favor off-pump coronary artery bypass grafting in patients with heparin-induced thrombocytopenia (HIT). Did Carrier and colleagues1 consider using a short-acting thrombin inhibitor such as bivalirudin (Angiomax) rather than danaparoid as the heparin alternative?

I have used bivalirudin,2 a short-acting thrombin inhibitor, in several patients with HIT who have required valve replacement. Bivalirudin's half-life of 25 minutes, the ability to monitor activated clotting time, and the lack of cross-reactivity with heparin antibodies were advantages that convinced my group to use it for these patients with HIT. The patients did well, requiring an average of 2 units of blood per patient.

My suspicion is that off-pump revascularization with bivalirudin rather than danaparoid would result in lower use of blood products. It is likely that even on-pump coronary artery bypass grafting with bivalirudin as the anticoagulant will result in lower blood product use in the HIT cohort.


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  1. Carrier M, Robitaille D, Perrault LP, Pellerin M, Page P, Cartier R, et al. Heparin versus danaparoid in off-pump coronary bypass grafting: results of a prospective randomized clinical trial. J Thorac Cardiovasc Surg. 2003;125:325–329[Abstract/Free Full Text]
  2. Vasquez JC, Vichiendilokkul A, Mahmood S, Baciewicz FA. Anticoagulation with bivalirudin during cardiopulmonary bypass in cardiac surgery. Ann Thorac Surg. 2002;74:2177–2179[Abstract/Free Full Text]




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