Summary. Background: Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated response to unfractionated heparin and, less commonly, low molecular weight heparin. It is associated with a high thrombotic risk and the potential for limb and lifethreatening complications. Argatroban is the only approved and currently available anticoagulant for HIT treatment in the USA. Objectives: To report safety and efficacy outcomes with bivalirudin for HIT treatment. Methods: We retrospectively examined records from our registry of patients with a suspected, confirmed or previous history of HIT and who had received bivalirudin for anticoagulation in a single tertiary-care center over a 9-year period. Results: We identified 461 patients who received bivalirudin: 220 (47.7%) were surgical patients, and 241 (52.3%) were medical patients. Of this population, 107 (23.2%) were critically ill, and 109 (23.6%) were dialysis-dependent. Suspected, confirmed and previous history of HIT were reported in 262, 124 and 75 patients, respectively. Of 386 patients with suspected or confirmed HIT, 223 patients (57.8%) had thrombosis at HIT diagnosis. New thrombosis was identified in 21 patients (4.6%) while they were on treatment with therapeutic doses of bivalirudin. No patient required HIT-related amputation. Major bleeding occurred in 35 patients (7.6%). We found a significant increase in major bleeding risk in the critically ill population (13.1%; odds ratio 2.4, 95% confidence interval 1.2-4.9, P = 0.014). The 30-day allcause mortality rate was 14.5% (67 patients), and eight of 67 (1.7%) deaths were HIT-related. Conclusion: Bivalirudin may be an effective and safe alternative option for the treatment of both suspected and confirmed HIT, and appears to reduce the rate of HITrelated amputation.

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Introduction: Atrial fibrillation (AF) is highly prevalent in the elderly. Our aim is to evaluate the safety and efficacy of catheter ablation (PVI) in this population. Hypothesis: Catheter ablation(PVI) for AF is less effective in the elderly population. Methods: Data of 6824 consecutive patients who had PVI between January 2006 and July 2013 were reviewed. Patients ≥ 75 years were included in the study. Ablation strategy included isolation of all pulmonary veins as well as left atrial(LA) substrate modification as needed. Procedural complications and success (defined as freedom from any atrial arrhythmia lasting more than 30 seconds) were analyzed. Results: This study included 402 consecutive patients who underwent 452 ablation procedures. Of those patients, 76 were ≥ 80 years old. The mean age was 77.6 ± 2.5. 166 (41%) were female, and 148 (37%) had persistent AF. The median lifetime AF duration was 5 years (IQR: 2.5, 10). The mean CHADS2-VASC was 3.47 ± 2 and mean LV EF was 55.3% ± 9.1. 90% of patients were anticoagulated with warfarin, 8% with dabigatran, 2% with rivaroxaban, and 1 with enoxaparin. 28% of patients were also on aspirin and 2% on clopidogrel. Median follow up period was 394 days (IQR: 182, 777). Major complications included 1 ischemic stroke, 5 cases of tamponade during ablation, 8 cases of groin hematoma that required intervention, and 1 case of hemothorax. Minor complications included 8 small hematomas, and 1 hemodynamically stable pericardial effusion. After a single ablation, 154 (38.3%) patients remained arythmia free. 118 (29.3%) had infrequent paroxysmal AF, 39 (9.7%) had persistent AF, 42 (10.4%) had paroxysmal AF and AFL/AT, and 14 (3.5%) had persistent AF and AFL/AT. 9 (2.2%) had AT/AFL only. 21 (5.2%) patients had incomplete follow up. Five (1.2%) procedures were aborted; 4 due to complications with trans-septal puncture, and 1 due to electric silence of the LA. 50 patients underwent repeat ablation, increasing the freedom of AF to 42.0% Conclusions: AF ablation in the elderly is associated with a minimal increase in complications, most commonly in the form of access site hematoma. However, success rates are lower than that previously reported in younger patients.

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