Document Detail


Bivalirudin compared with heparin during coronary angioplasty for thrombus-containing lesions.
MedLine Citation:
PMID:  9350925     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We investigated whether bivalirudin is more effective than heparin in preventing ischemic complications in high risk patients undergoing coronary angioplasty for thrombus-containing lesions detected by angiography. BACKGROUND: Heparin is administered during coronary angioplasty to prevent closure of the dilated vessel. Bivalirudin (Hirulog) is a direct thrombin inhibitor that can be safely substituted for heparin during angioplasty. Bivalirudin has several theoretic advantages over heparin as an anticoagulant agent. METHODS: We performed an observational analysis of the Hirulog Angioplasty Study in which 4,098 patients with unstable or postinfarction angina were randomized to receive either bivalirudin or heparin during coronary angioplasty. The study group for this analysis consisted of 567 patients who had thrombus-containing lesions on angiography. The primary end point was death, myocardial infarction, emergency coronary artery bypass graft surgery or abrupt vessel closure before hospital discharge. RESULTS: Patients with thrombus-containing lesions had a higher incidence of myocardial infarction (5.1% vs. 3.2%, p = 0.03) and abrupt vessel closure (13.6% vs. 8.3%, p < 0.001) than those without thrombus. In patients with thrombus-containing lesions, however, the incidence of the primary end point was not different between the bivalirudin and heparin treatment groups. Furthermore, no difference in the incidence of ischemic events at 6 months was seen between the treatment groups. CONCLUSIONS: Bivalirudin is not more effective than heparin in preventing ischemic complications in patients undergoing coronary angioplasty for thrombus-containing lesions detected by angiography. Other approaches, perhaps involving potent anti-platelet agents, should be considered for patients with thrombus-containing lesions.
Authors:
P B Shah; W H Ahmed; P Ganz; J A Bittl
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  30     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1997-11-17     Completed Date:  1997-11-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1264-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Anticoagulants / therapeutic use*
Antithrombins / therapeutic use*
Coronary Thrombosis / therapy*
Double-Blind Method
Female
Heparin / therapeutic use*
Hirudin Therapy
Hirudins / analogs & derivatives*
Humans
Male
Middle Aged
Multicenter Studies as Topic
Myocardial Ischemia / etiology,  prevention & control
Peptide Fragments / therapeutic use*
Randomized Controlled Trials as Topic
Recombinant Proteins / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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