Abstract 12936: Bivalirudin versus Unfractionated Heparin for Residual Thrombus Burden: A Frequency-Domain Optical Coherence Tomography Study
Introduction: The efficacy of bivalirudin to inhibit thrombus formation inside the stent during percutaneous coronary interventions (PCI) as compared to unfractionated heparin (UFH) is unknown.
Aim: This study aimed to compare the effect of bivalirudin and UFH on residual thrombus burden assessed by frequency-domain optical coherence tomography (FD-OCT), and on angiographic indices of microvascular obstruction (MVO).
Methods: Sixty patients with coronary artery disease who underwent post-PCI FD-OCT were studied, including 20 patients treated with bivalirudin and 40 control patients treated with UFH, matched by clinical presentation, stent characteristics, and periprocedural medications. In-stent thrombus volume, thrombus score (number of quadrants with thrombus), and thrombus type (white/red) were assessed by FD-OCT. Thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), and Quantitative Blush Evaluator (QuBE) score were recorded.
Results: Patients treated with bivalirudin showed similar thrombus volume (0.14 mm3 [0.00-0.88] vs. 0.13 mm3 [0.00-0.63], p=0.962), thrombus score (10 [0-25] vs. 8 [0-21], p=0.849) and thrombus length (1.70 mm [0.00-4.10] vs. 1.40 mm [0.00-4.05], p=0.968], but significantly lower proportion of white thrombus (55.5% vs. 78.6%, p=0.016) (Figure), as compared with patients treated with UFH. There was no difference in the angiographic indices of MVO between bivalirudin and UFH groups, including TIMI flow grade (TIMI flow grade ≤2: 15% vs. 10%; p=676), cTFC (16 [12-20] vs. 13 [11-17]; p=0.172), and QuBE score (15.3 [8.6-22.5] vs. 12.1 [8.5-19.4]; p=0.452).
Conclusions: The present study showed similar OCT residual thrombus burden and angiographic indices of MVO after PCI between bivalirudin and UFH groups. Patients treated with bivalirudin showed lower proportion of white thrombus, which may reflect a better inhibition of platelet function.
Author Disclosures: R. Vergallo: None. R. Joye: None. P. Barlis: None. H. Jia: None. J. Tian: None. T. Soeda: None. Y. Minami: None. S. Hu: None. H.L. Dauerman: None. C. Toma: None. J. Chan: None. H. Lee: None. L.M. Biasucci: None. F. Crea: None. I. Jang: None.
- © 2014 by American Heart Association, Inc.