Summary

Patients with diabetes who undergo percutaneous coronary intervention(PCI) are at high risk for thrombotic complicationsfollowing the procedure.We sought to compare the anti-thromboticeffect of bivalirudin to that of eptifibatide plus unfractionatedheparin in diabetic patients undergoing elective PCI.Thirtydiabetic patients were randomized to receive during PCI eitherbivalirudin (bivalirudin group, n=15) or eptifibatide plus heparin(eptifibatide group, n=15) at standard dosing regimens. Thedrugs were continued for 20 minutes (bivalirudin) or 18 hours(eptifibatide) after PCI. Blood thrombogenicity was assessedusing the Badimon ex vivo perfusion chamber. Each patientunderwent two perfusion studies – at baseline (on aspirin andclopidogrel) and 15–20 minutes following PCI. Perfusion studieswere performed at rheologic conditions of low and high shearrates (LSR, HSR). Porcine aortic tunica media served as the thrombogenic substrate. Aortic specimens were stained fortotal platelet-thrombus and fibrin deposition. Thrombus areawas measured using computerized planimetry. There were nodifferences in clinical characteristics or baseline thrombus areabetween the two groups.Total platelet-thrombus area was reducedsignificantly in both groups, but the degree of reductionwas lower in the bivalirudin group compared with the eptifibatidegroup (HSR: 69.5% vs. 89.3% reduction, respectively, P =0.04;LSR: 50.6% vs. 73.2%, P =0.03). Fibrin deposition was reduced inboth groups by 47–49%. In conclusion, both bivalirudin and thecombination of eptifibatide plus heparin, given to diabetic patientsduring PCI, achieved marked reductions in total thrombusformation and fibrin deposition. However, glycoprotein IIb/IIIainhibition by eptifibatide caused a more pronounced reductionin thrombus formation.