Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in high-risk patients undergoing percutaneous coronary intervention (from the Anti-Thrombotic Strategy for Reduction of Myocardial Damage During Angioplasty-Bivalirudin vs Heparin study)

The American Journal of Cardiology
Giuseppe PattiGermano Di Sciascio

Abstract

Bivalirudin, a direct thrombin inhibitor, is as effective as unfractionated heparin (UFH), with decreased bleeding in patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI). The aim of this study was to evaluate the effectiveness of bivalirudin versus UFH in selected PCI patients at high bleeding risk. Four hundred one consecutive patients who underwent PCI fulfilling ≥ 1 enrollment criterion (age >75 years, chronic renal failure, and diabetes mellitus) were randomized to bivalirudin (bolus 0.75 mg/kg followed by infusion during the procedure; n = 198) or UFH (75 IU/kg; n = 203). In the overall population, 39% were aged >75 years, 22% had renal failure, 63% had diabetes, and 29% had acute coronary syndromes. The primary efficacy end point was the 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization). The primary safety end point was the occurrence of any bleeding or entry-site complications after PCI. All patients were preloaded with clopidogrel 600 mg. Glycoprotein IIb/IIIa inhibitors were used at the operators' discretion. Thirty-day major adverse cardiac event rates were 11.1% in the bivalirudin group ...Continue Reading

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Citations

Aug 21, 2013·Best Practice & Research. Clinical Haematology·Nick van EsMichiel Coppens
Dec 18, 2013·Circulation Journal : Official Journal of the Japanese Circulation Society·Giuseppe PattiGermano Di Sciascio
Aug 21, 2014·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Ibrahim AkinMohamed Abdel-Wahab
Feb 26, 2016·European Heart Journal·Petr Widimský
Mar 11, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Farhad AbtahianIk-Kyung Jang
Aug 12, 2014·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Salvatore CasseseAdnan Kastrati
Apr 11, 2015·Pharmacology & Therapeutics·Thomas A Mavrakanas, Yiannis S Chatzizisis
Sep 8, 2015·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Kenneth TandjungClemens von Birgelen
Jan 23, 2014·Journal of Cardiothoracic and Vascular Anesthesia·Federico PappalardoAlberto Zangrillo
Mar 25, 2017·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·George S MinaPaari Dominic
Apr 15, 2018·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Thomas G NührenbergFranz-Josef Neumann
Oct 31, 2017·World Journal of Cardiology·Melorin MehrzadRaman Mehrzad
Jun 27, 2019·Cardiovascular & Hematological Disorders Drug Targets·Sukhdeep BhogalTimir K Paul

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