Document Detail


The effects of bivalirudin compared with those of unfractionated heparin plus eptifibatide on inflammation and thrombin generation and activity during coronary intervention.
MedLine Citation:
PMID:  16118546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To characterize effects of bivalirudin compared with unfractionated heparin plus eptifibatide on inflammation, and thrombin generation and activity after percutaneous coronary intervention. METHODS: We measured the concentration in blood of fibrinopeptide A, prothrombin fragment 1+2, soluble CD40 ligand, interleukin 1 receptor antagonist, interleukin 6, and high sensitivity C-reactive protein in 63 patients treated with aspirin and clopidogrel and undergoing elective percutaneous coronary intervention, who were randomized to treatment with either bivalirudin (n=34) or unfractionated heparin plus eptifibatide (n=29). RESULTS: Neither generation nor activity of thrombin increased 10 min after percutaneous coronary intervention in patients randomized to bivalirudin or unfractionated heparin plus eptifibatide. However, prothrombin fragment 1+2 increased modestly and comparably in both groups after 1 day. Inflammation, reflected by concentrations of interleukin 6 and high sensitivity C-reactive protein in blood, increased similarly 1 day after percutaneous coronary intervention in patients treated with either regimen. In a subset of patients (n=12 in each group) from whom blood was obtained 30 days after percutaneous coronary intervention, the concentration of high sensitivity C-reactive protein was lower in those who had been treated with bivalirudin (by 3.5 mg/l, P=0.002). CONCLUSION: The early effects on inflammation and thrombin generation and activity are similar after treatment with bivalirudin alone compared with unfractionated heparin plus eptifibatide in patients treated with aspirin and clopidogrel who are undergoing percutaneous coronary intervention for symptoms of stable angina. The decreased concentration of high sensitivity C-reactive protein seen 30 days after percutaneous coronary intervention in those treated with bivalirudin is consistent with greater attenuation of inflammation that may have contributed to the trend toward reduced mortality 1 year later in those treated with bivalirudin in REPLACE-2.
Authors:
Friederike K Keating; Harold L Dauerman; Deborah A Whitaker; Burton E Sobel; David J Schneider
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Coronary artery disease     Volume:  16     ISSN:  0954-6928     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-24     Completed Date:  2006-02-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  401-5     Citation Subset:  IM    
Affiliation:
Cardiology Unit, Department of Medicine, University of Vermont Burlington, Colchester, Vermont 05446, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Anticoagulants / therapeutic use
C-Reactive Protein / metabolism
CD40 Ligand / blood
Combined Modality Therapy
Coronary Artery Disease / blood,  therapy*
Female
Fibrinopeptide A / metabolism
Heparin / therapeutic use*
Hirudins
Humans
Interleukin-6 / blood
Male
Middle Aged
Peptide Fragments / metabolism,  therapeutic use*
Peptides / therapeutic use*
Platelet Aggregation Inhibitors / therapeutic use
Protein Precursors / metabolism
Prothrombin / metabolism
Receptors, Interleukin-1 / blood
Recombinant Proteins / therapeutic use
Thrombin / metabolism*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Interleukin-6; 0/Peptide Fragments; 0/Peptides; 0/Platelet Aggregation Inhibitors; 0/Protein Precursors; 0/Receptors, Interleukin-1; 0/Recombinant Proteins; 0/eptifibatide; 128270-60-0/bivalirudin; 147205-72-9/CD40 Ligand; 25422-31-5/Fibrinopeptide A; 72270-84-9/prothrombin fragment 1; 78768-79-3/prothrombin fragment 2; 9001-26-7/Prothrombin; 9005-49-6/Heparin; 9007-41-4/C-Reactive Protein; EC 3.4.21.5/Thrombin

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


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