Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes

The New England Journal of Medicine
Marco ValgimigliMATRIX Investigators

Abstract

Conflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome. We randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin. Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion. Primary outcomes for the comparison between bivalirudin and heparin were the occurrence of major adverse cardiovascular events (a composite of death, myocardial infarction, or stroke) and net adverse clinical events (a composite of major bleeding or a major adverse cardiovascular event). The primary outcome for the comparison of a post-PCI bivalirudin infusion with no post-PCI infusion was a composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events. The rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (10.3% and 10.9%, respectively; relative risk, 0.94; 95% confidence interval [CI], 0.81 to 1.09; P=0.44), nor was the rate of net adverse clinical events (11.2% and...Continue Reading

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Citations

Feb 16, 2016·Current Treatment Options in Cardiovascular Medicine·Jun LiSahil A Parikh
Feb 13, 2016·Journal of Interventional Cardiology·Cindy L GrinesTheodore L Schreiber
Nov 22, 2015·Journal of Thrombosis and Haemostasis : JTH·H Ten Cate
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Oct 19, 2016·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Marianna AdamoMarco Valgimigli

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