Document Detail


Bleeding risk and outcomes of Bivalirudin versus Glycoprotein IIb/IIIa inhibitors with targeted low-dose unfractionated Heparin in patients having percutaneous coronary intervention for either stable or unstable angina pectoris.
MedLine Citation:
PMID:  18602514     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
For patients undergoing elective percutaneous coronary intervention (PCI), procedural anticoagulation with bivalirudin was previously shown to significantly reduce bleeding complications at the cost of a modest increase in ischemic events compared with unfractionated heparin (UFH) and glycoprotein IIb/IIIa inhibitors (GPIs). However, the excess bleeding in patients treated with UFH and GPIs may have been caused by excessively high UFH doses and increased activated clotting times. This study sought to determine the bleeding risk of targeted low-dose UFH with GPIs compared with bivalirudin in patients undergoing elective PCI. Of 1,205 patients undergoing elective PCI, 602 underwent PCI with adjunctive UFH and GPIs with the UFH dose targeted to an activated clotting time of approximately 250 seconds, and 603 patients matched for baseline characteristics underwent PCI with bivalirudin. Outcomes were analyzed for major bleeding (hematocrit decrease >15%, gastrointestinal bleed, or major hematoma) and 6-month major adverse cardiac events (death, myocardial infarction, and target-lesion revascularization). The maximum activated clotting time achieved was 261.7 +/- 61.6 seconds in the UFH/GPI group and 355.4 +/- 66.6 in the bivalirudin group (p <0.001). In-hospital major bleeding rates were similar between groups (1.8% UFH/GPI vs 1.7% bivalirudin; p = 0.83), as were transfusion requirements (1.2% UFH/GPI vs 0.5% bivalirudin; p = 0.61). The 6-month major adverse cardiac event rate was also similar between groups (9.5% UFH/GPI vs 9.0% bivalirudin; p = 0.81). In conclusion, there were no significant differences in major bleeding and 6-month major adverse cardiac events for patients undergoing elective PCI treated with targeted low-dose UFH and GPIs compared with those treated with bivalirudin.
Authors:
Daniel H Steinberg; Palak Shah; Tim Kinnaird; Tina L Pinto Slottow; Probal K Roy; Teruo Okabe; Laurent Bonello; Axel de Labriolle; Kimberly A Smith; Rebecca Torguson; Zhenyi Xue; William O Suddath; Kenneth M Kent; Lowell F Satler; Augusto D Pichard; Joseph Lindsay; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-05-28
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-07     Completed Date:  2008-08-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  160-4     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
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MeSH Terms
Descriptor/Qualifier:
Angina Pectoris / drug therapy*
Angina, Unstable / drug therapy
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*
Anticoagulants / adverse effects*,  therapeutic use
Female
Hemorrhage / chemically induced*,  prevention & control
Heparin / adverse effects*,  therapeutic use
Hirudins / adverse effects*
Humans
Male
Middle Aged
Peptide Fragments / adverse effects*,  therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Postoperative Complications
Recombinant Proteins / adverse effects,  therapeutic use
Risk Assessment
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 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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