PMID- 17461699
OWN - NLM
STAT- MEDLINE
DCOM- 20070626
LR  - 20161124
IS  - 0277-0008 (Print)
IS  - 0277-0008 (Linking)
VI  - 27
IP  - 5
DP  - 2007 May
TI  - Comparison of patient outcomes with bivalirudin versus unfractionated heparin in 
      percutaneous coronary intervention.
PG  - 647-56
AB  - OBJECTIVE: To compare clinical outcomes and glycoprotein IIb-IIIa inhibitor use 
      in patients undergoing percutaneous coronary intervention (PCI) who received 
      bivalirudin or unfractionated heparin (UFH) in a real-world setting. DESIGN: 
      Retrospective cohort analysis. SETTING: University-affiliated medical center. 
      PATIENTS: One thousand seventy-five adult patients who underwent PCI and received 
      either bivalirudin (539 patients) or UFH (536 patients) from April 1, 2003-April 
      1, 2004. MEASUREMENT AND MAIN RESULTS: Patient data on demographics, 
      comorbidities, laboratory values, and reports of radiologic examinations, cardiac 
      catheterizations, and discharge summaries were obtained. Outcomes evaluated 
      included rates of in-hospital mortality, myocardial infarction, 
      revascularization, and length of stay (LOS), as well as Randomized Evaluation of 
      PCI Linking Angiomax to Reduced Clinical Events (REPLACE-2) and Thrombosis in 
      Myocardial Infarction (TIMI) bleeding categorization. Bivalirudin use was 
      associated with a significant reduction in TIMI major (5.0% vs 9.7%, p=0.003), 
      REPLACE-2 major (5.4% vs 12.9%, p<0.001), and TIMI minor (1.7% vs 6%, p<0.001) 
      bleeding complications compared with UFH use. Significantly fewer patients in the 
      bivalirudin group received glycoprotein IIb-IIIa inhibitors (27.3% vs 62.7%, 
      p<0.001). Patients receiving bivalirudin had significantly fewer myocardial 
      infarctions after catheterization (10.7% [40/375] vs 18.0% [51/284], p=0.007). No 
      differences were noted in mortality and revascularization rates between groups. A 
      shortened LOS was observed in the bivalirudin group. CONCLUSIONS: This real-world 
      analysis that included high-risk patients provides further evidence that 
      bivalirudin is an attractive alternative to UFH because of a decrease in bleeding 
      events without compromising efficacy.
FAU - Watson, Kristin
AU  - Watson K
AD  - Department of Pharmacy Practice and Sciences, School of Pharmacy, University of 
      Maryland, Baltimore, Maryland, USA.
FAU - Seybert, Amy L
AU  - Seybert AL
FAU - Saul, Melissa I
AU  - Saul MI
FAU - Lee, Joon Sup
AU  - Lee JS
FAU - Kane-Gill, Sandra L
AU  - Kane-Gill SL
LA  - eng
GR  - UL1 TR000005/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Cohort Studies
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Hospitals, University
MH  - Humans
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Infarction/drug therapy
MH  - Myocardial Revascularization
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Thrombosis
MH  - Treatment Outcome
EDAT- 2007/04/28 09:00
MHDA- 2007/06/27 09:00
CRDT- 2007/04/28 09:00
PHST- 2007/04/28 09:00 [pubmed]
PHST- 2007/06/27 09:00 [medline]
PHST- 2007/04/28 09:00 [entrez]
AID - 10.1592/phco.27.5.647 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2007 May;27(5):647-56. doi: 10.1592/phco.27.5.647.