PMID- 15815880
OWN - NLM
STAT- MEDLINE
DCOM- 20050823
LR  - 20181113
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 18
IP  - 3
DP  - 2004 Dec
TI  - Bleeding complications after contemporary pharmacoinvasive therapy for ST 
      elevation myocardial infarction.
PG  - 187-92
AB  - BACKGROUND: Pharmacoinvasive therapy for the treatment of ST elevation myocardial 
      infarction (STEMI) is a strategy that combines early restoration of coronary flow 
      via pharmacologically induced thrombolysis with subsequent, prompt percutaneous 
      coronary intervention (PCI). Prior studies suggesting a heightened bleeding risk 
      of PCI performed early after fibrinolysis predated contemporary pharmacoinvasive 
      practice including use of femoral closure devices (CD), fibrin specific 
      thrombolytics, lower doses of heparin and stents. METHODS: Consecutive patients 
      were included in this retrospective registry study if they underwent emergent PCI 
      for ST elevation myocardial infarction (STEMI) followed by immediate use of a 
      groin closure device. Between Oct 1, 2002 and Jan 1, 2003, 27 patients were 
      treated with immediate use of CD after post-thrombolytic PCI, performed within 12 
      hours of thrombolysis (pharmacoinvasive group). 58 patients were treated with 
      immediate use of CD after primary PCI for STEMI. The two groups were compared 
      with respect to the incidence of successful groin closure, bleeding 
      complications, and clinical outcomes. Bleeding events were categorized according 
      to the TIMI criteria. All baseline clinical and treatment variables were compared 
      between the two groups to determine and the association of these variables 
      (including use of thromblytic therapy) with TIMI major and TIMI minor bleeding 
      was determined. RESULTS: Pharmacoinvasive recanalization with PCI occurred 348 
      +/- 183 minutes after initiation of fibrinolytic therapy. Glycoprotein IIb/IIIa 
      inhibitors were used less frequently in the patients treated with a thrombolytic 
      agent (59% vs. 90%, p < 0.01). Successful immediate hemostasis was obtained with 
      CD in greater than 85% of patients in both groups (89% for pharmacoinvasive group 
      vs. 86% for primary PCI group, p = 0.89). No patient required vascular surgical 
      intervention. TIMI major bleeding and transfusion requirements were less than 5% 
      in both groups. Antecedent thrombolytic therapy was not a predictor of bleeding 
      complications after PCI. CONCLUSIONS: Use of CD as part of a contemporary 
      pharmacoinvasive strategy is associated with a low rate of major bleeding 
      complications.
FAU - Gutierrez, Matthew J
AU  - Gutierrez MJ
AD  - University of Vermont College of Medicine, Burlington, VT 05401, USA.
FAU - Aggarwal, Atul
AU  - Aggarwal A
FAU - Gilbert, Kristin
AU  - Gilbert K
FAU - Sobel, Burton E
AU  - Sobel BE
FAU - Dauerman, Harold L
AU  - Dauerman HL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/adverse effects
MH  - Blood Transfusion/methods
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects/therapeutic use
MH  - Hemorrhage/*chemically induced/therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Registries
MH  - Retrospective Studies
MH  - Thrombolytic Therapy/*adverse effects
EDAT- 2005/04/09 09:00
MHDA- 2005/08/24 09:00
CRDT- 2005/04/09 09:00
PHST- 2005/04/09 09:00 [pubmed]
PHST- 2005/08/24 09:00 [medline]
PHST- 2005/04/09 09:00 [entrez]
AID - 10.1007/s11239-005-0344-7 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2004 Dec;18(3):187-92. doi: 10.1007/s11239-005-0344-7.