PMID- 18412079
OWN - NLM
STAT- MEDLINE
DCOM- 20080529
LR  - 20181201
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 71
IP  - 6
DP  - 2008 May 1
TI  - What anti-thrombotic therapy is best with primary PCI for acute ST elevation 
      myocardial infarction: how should the HORIZONS trial change current practice?
PG  - 816-21
LID - 10.1002/ccd.21518 [doi]
AB  - The current standard of care for anti-thrombotic therapy with primary PCI for 
      acute ST elevation myocardial infarction (STEMI) is aspirin, clopidogrel, 
      unfractionated heparin and platelet glycoprotein IIb/IIIa inhibitors. However, 
      heparin and glycoprotein IIb/IIIa inhibitors are associated with a high incidence 
      of bleeding, and many of the trials documenting benefit with this therapy were 
      performed before the widespread use of stents and clopidogrel. Bivalirudin is a 
      direct thrombin inhibitor which has been found to have similar efficacy with less 
      bleeding compared with heparin plus glycoprotein IIb/IIIa inhibitors when used 
      with elective PCI and with PCI for unstable angina and non-ST elevation 
      myocardial infarction. The HORIZONS trial evaluated bivalirudin compared with 
      unfractionated heparin and IIb/IIIa inhibitors in patients with STEMI treated 
      with primary PCI and found similar MACE (major adverse cardiac events) with less 
      bleeding and a lower incidence of net adverse clinical events (MACE or major 
      bleeding) at 30 days. Mortality at 30 days was also significantly less with 
      bivalirudin. These results make a strong case for the use of bivalirudin with 
      primary PCI in the great majority of patients with STEMI, with the possible 
      exception of patients with cardiogenic shock or stent thrombosis, and patients 
      with a large thrombus burden or no re-flow following PCI. In the latter case, 
      platelet glycoprotein IIb/IIIa inhibitors would be used as a bail-out strategy.
CI  - 2008 Wiley-Liss, Inc.
FAU - Brodie, Bruce R
AU  - Brodie BR
AD  - LeBauer Cardiovascular Research Foundation, Moses Cone Heart and Vascular Center, 
      Greensboro, North Carolina, USA. bbrodie@triad.rr.com
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - EC 3.4.21.5 (Thrombin)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
CIN - Catheter Cardiovasc Interv. 2009 Mar 1;73(4):584-5. PMID: 19085914
MH  - Angioplasty, Balloon, Coronary/*adverse effects/instrumentation
MH  - Anticoagulants/therapeutic use
MH  - Aspirin/therapeutic use
MH  - Cardiovascular Diseases/etiology/mortality/*prevention & control
MH  - Clopidogrel
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Myocardial Infarction/mortality/*therapy
MH  - *Patient Selection
MH  - Peptide Fragments/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Practice Guidelines as Topic
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/therapeutic use
MH  - Research Design
MH  - Stents
MH  - Thrombin/antagonists & inhibitors
MH  - Thrombosis/etiology/prevention & control
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2008/04/17 09:00
MHDA- 2008/05/30 09:00
CRDT- 2008/04/17 09:00
PHST- 2008/04/17 09:00 [pubmed]
PHST- 2008/05/30 09:00 [medline]
PHST- 2008/04/17 09:00 [entrez]
AID - 10.1002/ccd.21518 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2008 May 1;71(6):816-21. doi: 10.1002/ccd.21518.