PMID- 17884370
OWN - NLM
STAT- MEDLINE
DCOM- 20071102
LR  - 20181201
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 100
IP  - 7
DP  - 2007 Oct 1
TI  - Efficacy and safety of triple antiplatelet therapy with and without concomitant 
      anticoagulation during elective percutaneous coronary intervention (the REMOVE 
      trial).
PG  - 1099-102
AB  - Adjunctive glycoprotein IIb/IIIa inhibition decreases ischemic events after 
      percutaneous coronary intervention (PCI) but is associated with increased 
      bleeding. We hypothesized that maximal antiplatelet therapy with aspirin, a 
      thienopyridine, and a glycoprotein IIb/IIIa inhibitor without unfractionated 
      heparin (UFH) would result in fewer bleeding complications and maintain efficacy 
      in elective PCI. A total of 159 patients undergoing elective PCI were randomized 
      to intraprocedural eptifibatide alone or eptifibatide plus UFH. Patients received 
      aspirin 325 mg and clopidogrel 300 mg before the procedure. The primary end point 
      was the Landefeld bleeding index. Secondary end points included the composite 
      clinical outcome of in-hospital death, myocardial infarction, urgent target 
      vessel revascularization, and Thrombolysis In Myocardial Infarction major 
      bleeding, and a composite bleeding outcome of major, minor, and nuisance 
      bleeding. The Landefeld bleeding index was significantly lower in the 
      eptifibatide-only group compared with the eptifibatide-plus-UFH group (3.0 vs 
      3.9, p = 0.03). There was no significant difference in the composite clinical end 
      point between groups (eptifibatide only 17% vs eptifibatide plus UFH 15%, p = 
      0.7). There was a trend toward a decrease in the composite bleeding end point in 
      the eptifibatide-only compared with the eptifibatide-plus-UFH group (43% vs 56%, 
      p = 0.10). In conclusion, during elective PCI, a strategy of aggressive 
      antiplatelet therapy using aspirin, clopidogrel, and eptifibatide without 
      anticoagulant therapy appears to decrease bleeding complications.
FAU - Valencia, Rafael
AU  - Valencia R
AD  - Department of Cardiovascular Diseases, Scripps Clinic, La Jolla, California.
FAU - Price, Matthew J
AU  - Price MJ
FAU - Sawhney, Neil
AU  - Sawhney N
FAU - Lee, Steve S
AU  - Lee SS
FAU - Wong, Garrett B
AU  - Wong GB
FAU - Gollapudi, Raghava R
AU  - Gollapudi RR
FAU - Banares, Michelle
AU  - Banares M
FAU - Schatz, Richard A
AU  - Schatz RA
FAU - Teirstein, Paul S
AU  - Teirstein PS
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20070718
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 0 (Peptides)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Pyridines)
RN  - 0 (thienopyridine)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - NA8320J834 (Eptifibatide)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Clopidogrel
MH  - Coronary Artery Disease/drug therapy/*therapy
MH  - Drug Therapy, Combination
MH  - Eptifibatide
MH  - Female
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptides/therapeutic use
MH  - Pilot Projects
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Prospective Studies
MH  - Pyridines/therapeutic use
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2007/09/22 09:00
MHDA- 2007/11/06 09:00
CRDT- 2007/09/22 09:00
PHST- 2007/01/25 00:00 [received]
PHST- 2007/04/24 00:00 [revised]
PHST- 2007/04/24 00:00 [accepted]
PHST- 2007/09/22 09:00 [pubmed]
PHST- 2007/11/06 09:00 [medline]
PHST- 2007/09/22 09:00 [entrez]
AID - S0002-9149(07)01252-0 [pii]
AID - 10.1016/j.amjcard.2007.04.057 [doi]
PST - ppublish
SO  - Am J Cardiol. 2007 Oct 1;100(7):1099-102. doi: 10.1016/j.amjcard.2007.04.057. 
      Epub 2007 Jul 18.