Document Detail

Direct thrombin inhibition appears to be a safe and effective anticoagulant for percutaneous bypass graft interventions.
MedLine Citation:
PMID:  16892428     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Percutaneous coronary interventions (PCI) of coronary artery bypass grafts (CABG) are associated with worse outcomes compared with those of native coronary PCI. Little is known concerning the use of direct thrombin inhibition during CABG intervention. The objective of this report is to examine the safety and efficacy of bivalirudin with GPIIb/IIIa blockade inhibition in patients undergoing CABG PCI. GP IIb/IIIa use was provisional in REPLACE-2 and planned in REPLACE-1. METHODS AND RESULTS: A post hoc analysis of patients undergoing CABG PCI in the REPLACE-1 and -2 trials was performed. In REPLACE-1, patients were randomized to either heparin or bivalirudin, with GP IIb/IIIa inhibitor use at the operator's discretion. In REPLACE-2, patients were randomized to heparin plus GP IIb/IIIa inhibition versus bivalirudin with provisional GP IIb/IIIa blockade. In both studies, randomized treatment groups were well matched. In unadjusted and logistic regression analysis, there were no significant differences in the combined endpoint of death, myocardial infarction, urgent revascularization, or major bleeding when patients were treated with either heparin or bivalirudin. Individual safety and efficacy endpoints were also similar. Minor bleeding was significantly reduced in patients treated with bivalirudin (14.8% vs. 22.7%, P = 0.037). Follow-up data available from the REPLACE-2 trial at 12 months found similar efficacy between groups with a trend towards decreased 12 month mortality in the bivalirudin vs. heparin groups (4.2% vs. 7.8%, P = 0.16). CONCLUSION: CABG PCI using bivalirudin with provisional GPIIb/IIIa inhibition appears to provide similar safety and efficacy to heparin with GPIIb/IIIa inhibition.
John Kao; A Michael Lincoff; Eric J Topol; Antonio Madrid; Matthew J Price; Neil Sawhney; Paul S Teirstein
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  68     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-04     Completed Date:  2007-06-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  352-6     Citation Subset:  IM    
Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Anticoagulants / therapeutic use
Antithrombins / therapeutic use*
Combined Modality Therapy
Coronary Artery Bypass*
Coronary Disease / therapy*
Endpoint Determination
Follow-Up Studies
Heparin / therapeutic use
Logistic Models
Middle Aged
Peptide Fragments / therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Recombinant Proteins / therapeutic use
Retrospective Studies
Survival Analysis
Thrombin / antagonists & inhibitors*
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin; EC

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

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