| Effectiveness and safety of bivalirudin during percutaneous coronary intervention in a single medical center. | |
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MedLine Citation:
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PMID: 15757596 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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A recent large-scale, randomized trial demonstrated the noninferiority of a strategy of bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibition compared with routine GP IIb/IIIa inhibition. There is a paucity of outcome data with bivalirudin use in the setting of real-world experience. We evaluated 6,996 patients who underwent percutaneous coronary intervention between January 2001 and December 2004 to compare early and late outcomes with a bivalirudin-based antithrombotic regimen with those with a heparin-based regimen. Propensity adjustment was performed to correct for baseline differences in patient characteristics. Bivalirudin-based therapy was used in 1,070 patients, heparin only in 801 patients, and heparin plus GP IIb/IIIa inhibitors in 5,125 patients. Compared with patients who received heparin or those who received heparin plus GP IIb/IIIa inhibitors, patients who received bivalirudin had lower incidences of bleeding (blood transfusion rate 1.7% vs 4.0%, p <0.001) and periprocedural myonecrosis (creatine kinase-MB >5 times the upper limit of normal 2.7% vs 4.3%, p = 0.016). Differences in bleeding end points remained significant after adjusting for the propensity to receive bivalirudin, but there was no difference in ischemic events. There was no difference in unadjusted long-term survival rate (log-rank test p = 0.46, total number of deaths 412, mean follow-up 17 months) or in propensity-adjusted long-term survival rate (hazard ratio 1.37, 95% confidence interval 0.90 to 2.08, p = 0.14). Compared with heparin with or without GP IIb/IIIa inhibition, the use of bivalirudin in a large consecutive patient registry at a tertiary care center was associated with fewer bleeding events and no evident increase in the incidence of ischemic complications. |
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Authors:
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Hitinder S Gurm; Vivek Rajagopal; Robert Fathi; Deepak Vivekanathan; Jay S Yadav; Deepak L Bhatt; Stephen G Ellis; A Michael Lincoff; Eric J Topol |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 95 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-03-10 Completed Date: 2005-04-21 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 716-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Cohort Studies Coronary Restenosis / mortality, therapy Coronary Stenosis / therapy* Creatine Kinase / blood Creatine Kinase, MB Form Drug Therapy, Combination Female Fibrinolytic Agents / administration & dosage*, adverse effects Follow-Up Studies Hemorrhage / chemically induced Heparin / administration & dosage, adverse effects Hirudins / administration & dosage*, adverse effects, analogs & derivatives* Humans Isoenzymes / blood Male Middle Aged Myocardial Infarction / mortality, therapy Ohio Peptide Fragments / administration & dosage*, adverse effects Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Prospective Studies Recombinant Proteins / administration & dosage*, adverse effects Survival Analysis Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Hirudins; 0/Isoenzymes; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form |
| Comments/Corrections | |
Comment In:
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Nat Clin Pract Cardiovasc Med. 2005 Aug;2(8):384-5
[PMID:
16119695
]
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Erratum In:
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Am J Cardiol. 2005 Jul 15;96(2):324 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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