Commentary: bivalirudin is a safe and effective anticoagulant in the percutaneous treatment of complex infrainguinal disease.

摘要

Percutaneous peripheral interventions (PPI) are associated with higher rates of throm-botic and bleeding complications than percutaneous coronary interventions (PCI). These complications are a source of morbidity and increased cost. Possible explanations for the higher rates of thrombotic complications in PPI include: larger sheath sizes, which may be partially or totally occlusive; longer lesions; higher thrombus burden; and hypercoagulability with increased platelet aggregation. Increased bleeding complications in PPI may be related to larger sheath sizes, antegrade and other alternative access approaches, and less elastic vasculature. In this issue of JEVT, Shammas and colleagues retrospectively analyze outcomes in 398 consecutive PPIs at 2 centers. Most of the interventions were for infrainguinal disease. The treated lesions were long, with more than one third classified as TASC D. Angiographic thrombus was present in 7.8% of the bivalirudin cohort and 4.2% of the unfractionated heparin (UFH) cohort. The overwhelming majority (369, 93%) were treated with bivalirudin and 29 (7%) with UFH. Bleeding and thrombotic complications were low in both groups, with inadequate numbers in the heparin-treated group to make meaningful comparison.