Document Detail

Head-to-head comparison of bivalirudin versus heparin without glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction undergoing primary angioplasty.
MedLine Citation:
PMID:  19595396     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients receiving primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI), bivalirudin with provisional glycoprotein (GP) IIb/IIIa inhibitors has been demonstrated to be noninferior to heparin plus systematic GP IIb/IIIa inhibitors in preventing recurrent ischemic events with improved safety in terms of bleeding. However, no study has been performed comparing head-to-head bivalirudin with heparin without GP IIb/IIIa inhibitor infusion in STEMI patients. METHODS: We retrospectively studied 899 consecutive patients who presented with STEMI treated by primary angioplasty within 12 h after symptoms. Among them, 566 received bivalirudin and 333 received unfractionated heparin. Their in-hospital outcome in terms of efficacy and safety was assessed using rates of major adverse cardiac events (MACE) and major bleeding, respectively. Clinical, angiographic and procedural characteristics were well matched between the two groups. RESULTS: Patients in the heparin group more frequently required intra-aortic balloon pumping (6.6% vs. 3.6%, P=.037). Regarding the safety end point, the MACE rate, including death, ischemic stroke and urgent repeated revascularization, was low and similar in both groups (2.7% bivalirudin vs. 1.2% heparin, P=.15). The rate of major bleeding, including major hematoma, gastrointestinal bleeding and hematocrit drop >15% during hospitalization, was high and identical in the two groups (4.1% bivalirudin vs. 4.2% heparin, P=.92). CONCLUSION: This study suggests that bivalirudin and heparin present similar safety and efficacy profiles when used without GP IIb/IIIa inhibitor infusion during primary angioplasty.
Laurent Bonello; Axel de Labriolle; Probal Roy; Daniel H Steinberg; Tina L Pinto Slottow; Zhenyi Xue; Kimberly Kaneshige; Rebecca Torguson; William O Suddath; Lowell F Satler; Kenneth M Kent; Augusto D Pichard; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  10     ISSN:  1878-0938     ISO Abbreviation:  -     Publication Date:    2009 Jul-Sep
Date Detail:
Created Date:  2009-07-14     Completed Date:  2009-09-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  156-61     Citation Subset:  IM    
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects,  mortality
Brain Ischemia / etiology,  prevention & control
Fibrinolytic Agents / adverse effects,  therapeutic use*
Heart Diseases / etiology,  prevention & control
Hemorrhage / chemically induced
Heparin / adverse effects,  therapeutic use*
Hirudins / adverse effects
Intra-Aortic Balloon Pumping
Middle Aged
Myocardial Infarction / mortality,  therapy*
Peptide Fragments / adverse effects,  therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Recombinant Proteins / adverse effects,  therapeutic use
Retrospective Studies
Risk Assessment
Stroke / etiology,  prevention & control
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; 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

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

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