Document Detail


Validation of long-term benefits of bivalirudin versus unfractionated heparin in routine clinical practice after percutaneous coronary intervention.
MedLine Citation:
PMID:  21029818     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Randomized controlled trials have shown improved short-term bleeding outcomes for bivalirudin compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) for stable angina and acute coronary syndrome. This study analyzed the impact of bivalirudin-based anticoagulation strategy versus UFH-based anticoagulation strategy on long-term bleeding complications and major adverse cardiac events in patients undergoing PCI in routine clinical practice. From September 2005 to April 2009, 3,367 consecutive patients who underwent PCI for stable angina or non-ST-segment elevation acute coronary syndrome at Brigham and Women's Hospital were studied. Of these patients, 2,228 patients (66%) received UFH and 1,139 (34%) received bivalirudin. Bleeding complication and major adverse cardiac event rates were compared at discharge, 30 days, and 1 year. In a propensity-score matched analysis, bivalirudin-based anticoagulation strategy was associated with lower bleeding complications at 30 days (7.0% vs 13.7%, p = 0.001) and 1 year (12.7% vs 18.9%, p = 0.013). Major adverse cardiac event rates were not significantly different between groups at discharge, 30 days, and 1 year (6.4% vs 8.3%, p = 0.103; 9.4% vs 10.9%, p = 0.449; 12.1% vs 14.8%, p = 0.235, respectively). There was no difference in all-cause mortality rates between the 2 groups (0.9% vs 0.8%, p = 0.808, at discharge; 1.9% vs 3.6%, p = 0.112, at 30 days; 3.6% vs 5.5%, p = 0.195, at 1 year). In conclusion, in a real-world cohort of patients undergoing PCI, bivalirudin-based anticoagulation strategy is associated with a significant decrease in risk of bleeding complications after 30 days and 1 year compared to a UFH-based anticoagulation strategy with no increase in risk for major adverse cardiac events.
Authors:
Venkatesan D Vidi; Michael E Matheny; Vikram Agarwal; Nipun Arora; Sharon Donnelly; Sripal Bangalore; Frederic S Resnic
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2010-09-09
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-29     Completed Date:  2010-12-02     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1234-40     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / mortality,  therapy*
Angioplasty, Balloon, Coronary
Anticoagulants / adverse effects*,  therapeutic use
Chi-Square Distribution
Combined Modality Therapy
Female
Hemorrhage / chemically induced*,  epidemiology
Heparin / adverse effects*,  therapeutic use
Hirudins / adverse effects*
Humans
Incidence
Logistic Models
Male
Myocardial Infarction / mortality,  therapy*
Peptide Fragments / adverse effects*,  therapeutic use
Propensity Score
Prospective Studies
Recombinant Proteins / adverse effects,  therapeutic use
Risk Factors
Grant Support
ID/Acronym/Agency:
R01 LM008142/LM/NLM NIH HHS; R01-LM008142/LM/NLM NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin
Comments/Corrections

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


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