| Bivalirudin compared with heparin during coronary angioplasty for thrombus-containing lesions. | |
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MedLine Citation:
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PMID: 9350925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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P B Shah; W H Ahmed; P Ganz; J A Bittl |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 1997-11-17 Completed Date: 1997-11-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1264-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin |
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