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Comparison of bivalirudin versus heparin on radial artery occlusion after transradial catheterization

Background: Anticoagulant therapy is required to prevent radial artery occlusion (RAO) after transradial catheterization. There is no data comparing bivalirudin to standard heparin. Methods: We studied 400 consecutive patients. In case of diagnostic angiography‐only (n = 200), they received an intravenous bolus of heparin (70 U kg−1) immediately before sheath removal whereas in case of angiography followed by ad hoc percutaneous coronary intervention (n = 200), they received bivalirudin (bolus 0.75 mg kg−1, followed by infusion at 1.75 mg/kg/h). RAO was assessed 4–8 weeks later using two‐dimensional echography‐doppler and reverse Allen's test with pulse oximetry. Results: At follow‐up, 21 of the 400 (5.3%) patients were found to have RAO with no significant difference between the two groups (3.5% bivalirudin vs. 7.0% heparin, P = 0.18). Patients with RAO had a significantly lower weight compared to patients without RAO (78 ± 13 kg vs. 86 ± 18 kg, P = 0.011). By multivariate analysis, a weight <84 kg (OR: 2.78, 95% CI 1.08–8.00, P = 0.032) and a procedure duration ≤20 min (OR: 7.52, 95% CI 1.57–36.0, P = 0.011) remained strong independent predictors of RAO. All cases of radial occlusion were asymptomatic and without clinical sequelae. Conclusion: Delayed administration of bivalirudin or heparin for transradial catheterization provides similar efficacy in preventing RAO. Because of its low cost, a single bolus of heparin can be preferred in case of diagnostic angiography whereas bivalirudin can be contemplated in case of ad hoc percutaneous coronary intervention. © 2010 Wiley‐Liss, Inc.