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European Heart Journal Advance Access originally published online on May 7, 2008
European Heart Journal 2008 29(12):1504-1509; doi:10.1093/eurheartj/ehn195
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Impact of bivalirudin or unfractionated heparin on platelet aggregation in patients pretreated with 600 mg clopidogrel undergoing elective percutaneous coronary intervention

Dirk Sibbing{dagger}, Gabriele Busch{dagger}, Siegmund Braun, Stefan Jawansky, Albert Schömig, Adnan Kastrati, Ilka Ott and Nicolas von Beckerath*

Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany

Received 14 December 2007; revised 15 March 2008; accepted 18 April 2008; online publish-ahead-of-print 7 May 2008.

* Corresponding author. Tel: +49 89 4140 2689, Fax: +49 89 4140 6668, Email: beckerath{at}dhm.mhn.de

Aims: The aim of this study was to assess the impact of bivalirudin or unfractionated heparin (UFH) on platelet aggregation in patients, pretreated with a 600 mg loading dose clopidogrel, undergoing elective percutaneous coronary intervention (PCI).

Methods and results: Patients (n = 100) were recruited consecutively in the setting of a double-blind, randomized trial. Bivalirudin or UFH was administered during PCI. Blood was drawn immediately before PCI, following administration of bivalirudin or UFH directly after PCI, and 24 h after PCI. Adenosine diphosphate (ADP)-induced platelet aggregation was assessed with light transmission aggregometry (LTA) and multiple electrode aggregometry (MEA). Before PCI, ADP-induced platelet aggregation was similar in UFH and bivalirudin patients (P = 0.99 for LTA; P = 0.28 for MEA). Administration of bivalirudin during PCI resulted in significant additional suppression of platelet aggregation (P = 0.012 for LTA; P = 0.008 for MEA). Administration of UFH did not have a significant influence on platelet aggregation (P = 0.42 for LTA; P = 0.78 for MEA). Platelet aggregation was again similar in the two groups 24 h after PCI (P > 0.05 for LTA and MEA).

Conclusion: Bivalirudin, given during PCI in patients pretreated with 600 mg of clopidogrel, is in contrast to UFH associated with further inhibition of platelet aggregation.

Key Words: Bivalirudin • Clopidogrel • Unfractionated heparin • Platelet aggregation • Whole blood aggregometry

{dagger} Both authors contributed equally.


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