Document Detail


Feasibility and safety of prehospital administration of bivalirudin in patients with ST-elevation myocardial infarction.
MedLine Citation:
PMID:  19539068     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but to significantly reduce the risk of bleeding complications in patients with acute coronary syndromes. The aim of this preliminary study was to describe the feasibility and safety of a switch from prehospital administration of unfractionated heparin to bivalirudin in ST-elevation acute myocardial infarction (STEMI) patients referred for primary percutaneous coronary intervention. Patients with STEMI treated with a 1-mg/kg bivalirudin bolus in the ambulance followed by infusion during angiography/primary percutaneous coronary intervention were compared with a STEMI control group (from the preceding year) treated with 10,000 U unfractionated heparin in the ambulance followed by in-hospital treatment with a GPI. A total of 102 patients (59%) receiving bivalirudin and 72 receiving heparin were followed during hospitalization. The baseline characteristics and prehospital treatment times were comparable between the 2 groups. The thrombolysis in myocardial infarction flow before and after primary percutaneous coronary intervention was similar. Stents were used significantly more often in the heparin-treated patients (90% versus 76%; p = 0.04), with bailout GPI for those receiving bivalirudin occurring in 30% compared with 83% of those receiving heparin (p <0.001). Significant bleeding complications were seen in <10% of all patients undergoing angiography with no difference between groups. Bivalirudin was easy to administer in the prehospital setting and did not affect the prehospital run times. In conclusion, the results suggest that prehospital bivalirudin administration is as safe and effective as heparin in the treatment of patients with STEMI. Prehospital administration seemed to reduce the need for GPI.
Authors:
Maria Sejersten; Søren Loumann Nielsen; Thomas Engstrøm; Erik Jørgensen; Peter Clemmensen
Related Documents :
11174738 - Comparison of two heparin-coated extracorporeal circuits with reduced systemic anticoag...
8298418 - Collaborative overview of randomised trials of antiplatelet therapy--i: prevention of d...
18757948 - Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in ...
11966338 - Antithrombotic treatment and the incidence of angina pectoris.
12487638 - Paroxysmal ventricular tachycardia due to interventricular hydatid cyst.
12514628 - Usefulness of combined quantitative assessment of myocardial perfusion and velocities b...
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-04-16
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1635-40     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. msejersten@hotmail.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Anticoagulants / administration & dosage*
Antithrombins
Dose-Response Relationship, Drug
Electrocardiography*
Emergency Medical Services / methods*
Feasibility Studies
Female
Follow-Up Studies
Hirudins / administration & dosage*
Humans
Infusions, Intravenous
Male
Middle Aged
Myocardial Infarction / drug therapy*,  physiopathology
Peptide Fragments / administration & dosage*
Pilot Projects
Prospective Studies
Recombinant Proteins / administration & dosage
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antithrombins; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin

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


Previous Document:  Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction.
Next Document:  Predictive value of heart rate recovery and peak oxygen consumption for long-term mortality in patie...