Document Detail


Safety and efficacy of bivalirudin for percutaneous coronary intervention with rotational atherectomy.
MedLine Citation:
PMID:  20636842     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Although bivalirudin use in percutaneous coronary intervention (PCI) results in less bleeding compared to unfractionated heparin (UFH) use, its safety in patients undergoing rotational atherectomy (RA) is unknown.
METHODS: A cohort of 503 patients who underwent PCI with RA from 2000 to 2009 was studied. Patients receiving bivalirudin (n = 322) were compared to those (n = 181) treated with UFH +/- glycoprotein IIb/IIIa inhibitor (GPI) as PCI anticoagulation. Safety was assessed by the frequency of major bleeding (hematocrit drop > or =15%, intracerebral or gastro-intestinal bleeding) and need for transfusion. Efficacy was assessed by a composite end-point of in-hospital death, Q wave myocardial infarction (MI) or urgent coronary artery bypass graft (CABG).
RESULTS: Those in the bivalirudin group were older, more hypertensive, and had greater body mass index. The UFH group was more likely to have prior MI, prior CABG, and an acute coronary syndrome at baseline. GPI was used in 93 patients (52%) of the UFH group. No difference was found between groups for the composite of death/Q wave MI/urgent CABG (1.9% vs. 1.7%, respectively, in bivalirudin vs. UFH group; P = 0.2). The frequency of major bleeding (2.2% vs. 1.7%; P = 0.8) or transfusion (5.6% vs. 8.7%; P = 0.9) was also similar between groups. After adjustment, bivalirudin use was not associated with a reduction in death/Q wave MI/urgent CABG, major bleeding, or transfusion compared to UFH.
CONCLUSION: Bivalirudin use seems to be as safe and effective as UFH in patients undergoing RA.
Authors:
Cedric Delhaye; Kohei Wakabayashi; Gabriel Maluenda; Itsik Ben-Dor; Rebecca Torguson; Zhenyi Xue; William O Suddath; Lowell F Satler; Augusto D Pichard; Kenneth M Kent; Joseph Lindsay; Ron Waksman
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  23     ISSN:  1540-8183     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  223-9     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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Comment In:
J Interv Cardiol. 2010 Jun;23(3):230-2   [PMID:  20636843 ]

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