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Bivalirudin (Angiomax) Use during Intracoronary Brachytherapy May Predispose to Acute Closure

Central Cardiology Medical Clinic, 2110 Truxtun Avenue, Bakersfield, CA 93301

Brijesh Bhambi, MD

William Nyitray, MD

Kirit Desai

Central Cardiology Medical Clinic

Dean L. Davis, MD

Bakersfield Memorial Hospital; Florence Wheeler Cancer Center

Geetanjali Sharma, MD

Kern Medical Center, Bakersfield, CA

Pankaj Shukla, MD

Bakersfield Memorial Hospital

Carla File, RN

Tetsuo Ishimori, MD

Central Cardiology Medical Clinic

We describe two cases of intracoronary vascular brachytherapy where bivalirudin (Angiomax), employed as an anticoagulant, led to abrupt vessel closure or threatened abrupt closure. Use of bivalirudin (Angiomax) during intracoronary brachytherapy may predispose to the formation of intracoronary thrombus, related to the reversible binding kinetics of the bivalirudin to thrombin, and resulting in recovery of thrombin functional activity during periods of prolonged stasis that occur during intracoronary brachytherapy. Intracoronary abciximab administration may be a useful strategy in resolving the acute closure, since abciximab administered early during the formation of thrombus has been shown to facilitate clot lysis.

Key Words: vascular brachytherapy • intracoronary brachytherapy • bivalirudin (Angiomax) • intracoronary thrombus • acute closure

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 8, No. 1, 9-15 (2003)
DOI: 10.1177/107424840300800i103


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