Document Detail


HORIZONS trial: a step forward for primary percutaneous coronary intervention.
MedLine Citation:
PMID:  19210208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Bivalirudin has been associated with decreased bleeding, with similar rates of ischemia in patients with stable angina, unstable angina, non-ST elevation myocardial infarction and elective percutaneous coronary intervention (PCI). The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial tested whether with primary PCI, bivalirudin--compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor--reduced bleeding and net clinical benefit (bleeding, death, reinfarction, target-vessel revascularization for ischemia or stroke). Bivalirudin reduced major bleeding by 40% (4.9 vs 8.3%; risk ratio [RR]: 0.60; 95% confidence interval [CI]: 0.46-0.77; p < 0.0001) as compared with unfractionated heparin and a IIb/IIIa antagonist. Net adverse clinical events were reduced (9.2 vs 12.1%; RR: 0.76: 95% CI: 0.63-0.92; p = 0.005). Cardiac death and total death at 30 days were reduced with bivalirudin (1.8 vs 2.9%; p = 0.03) and (2.1 vs 3.1%; p = 0.047), and at 12 months (2.1 vs 3.8%; p < 0.005) and (3.4 vs 4.8%; p = 0.029), respectively. Bivalirudin reduced bleeding and net adverse clinical events as well as mortality compared with unfractionated heparin and a glycoprotein IIb/IIIa inhibitor. Bivalirudin is an attractive antithrombotic choice in patients undergoing primary PCI.
Authors:
Harvey D White
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Expert review of cardiovascular therapy     Volume:  7     ISSN:  1744-8344     ISO Abbreviation:  Expert Rev Cardiovasc Ther     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-12     Completed Date:  2009-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101182328     Medline TA:  Expert Rev Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  125-9     Citation Subset:  IM    
Affiliation:
Green Lane Cardiovascular Service, Auckland City Hospital, Level 3, Building 32, Private Bag 92 024, Auckland 1030, New Zealand. harveyw@adhb.govt.nz
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary*
Anticoagulants / adverse effects,  therapeutic use*
Follow-Up Studies
Hemorrhage / chemically induced
Heparin / adverse effects,  therapeutic use
Hirudins / adverse effects
Humans
Myocardial Infarction / mortality,  therapy*
Peptide Fragments / adverse effects,  therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / adverse effects,  therapeutic use
Randomized Controlled Trials as Topic
Recombinant Proteins / adverse effects,  therapeutic use
Stents
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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