PMID- 18602514
OWN - NLM
STAT- MEDLINE
DCOM- 20080829
LR  - 20161124
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 102
IP  - 2
DP  - 2008 Jul 15
TI  - Bleeding risk and outcomes of Bivalirudin versus Glycoprotein IIb/IIIa inhibitors 
      with targeted low-dose unfractionated Heparin in patients having percutaneous 
      coronary intervention for either stable or unstable angina pectoris.
PG  - 160-4
LID - 10.1016/j.amjcard.2008.03.030 [doi]
AB  - For patients undergoing elective percutaneous coronary intervention (PCI), 
      procedural anticoagulation with bivalirudin was previously shown to significantly 
      reduce bleeding complications at the cost of a modest increase in ischemic events 
      compared with unfractionated heparin (UFH) and glycoprotein IIb/IIIa inhibitors 
      (GPIs). However, the excess bleeding in patients treated with UFH and GPIs may 
      have been caused by excessively high UFH doses and increased activated clotting 
      times. This study sought to determine the bleeding risk of targeted low-dose UFH 
      with GPIs compared with bivalirudin in patients undergoing elective PCI. Of 1,205 
      patients undergoing elective PCI, 602 underwent PCI with adjunctive UFH and GPIs 
      with the UFH dose targeted to an activated clotting time of approximately 250 
      seconds, and 603 patients matched for baseline characteristics underwent PCI with 
      bivalirudin. Outcomes were analyzed for major bleeding (hematocrit decrease >15%, 
      gastrointestinal bleed, or major hematoma) and 6-month major adverse cardiac 
      events (death, myocardial infarction, and target-lesion revascularization). The 
      maximum activated clotting time achieved was 261.7 +/- 61.6 seconds in the 
      UFH/GPI group and 355.4 +/- 66.6 in the bivalirudin group (p <0.001). In-hospital 
      major bleeding rates were similar between groups (1.8% UFH/GPI vs 1.7% 
      bivalirudin; p = 0.83), as were transfusion requirements (1.2% UFH/GPI vs 0.5% 
      bivalirudin; p = 0.61). The 6-month major adverse cardiac event rate was also 
      similar between groups (9.5% UFH/GPI vs 9.0% bivalirudin; p = 0.81). In 
      conclusion, there were no significant differences in major bleeding and 6-month 
      major adverse cardiac events for patients undergoing elective PCI treated with 
      targeted low-dose UFH and GPIs compared with those treated with bivalirudin.
FAU - Steinberg, Daniel H
AU  - Steinberg DH
AD  - Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
FAU - Shah, Palak
AU  - Shah P
FAU - Kinnaird, Tim
AU  - Kinnaird T
FAU - Pinto Slottow, Tina L
AU  - Pinto Slottow TL
FAU - Roy, Probal K
AU  - Roy PK
FAU - Okabe, Teruo
AU  - Okabe T
FAU - Bonello, Laurent
AU  - Bonello L
FAU - de Labriolle, Axel
AU  - de Labriolle A
FAU - Smith, Kimberly A
AU  - Smith KA
FAU - Torguson, Rebecca
AU  - Torguson R
FAU - Xue, Zhenyi
AU  - Xue Z
FAU - Suddath, William O
AU  - Suddath WO
FAU - Kent, Kenneth M
AU  - Kent KM
FAU - Satler, Lowell F
AU  - Satler LF
FAU - Pichard, Augusto D
AU  - Pichard AD
FAU - Lindsay, Joseph
AU  - Lindsay J
FAU - Waksman, Ron
AU  - Waksman R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20080528
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Angina Pectoris/*drug therapy
MH  - Angina, Unstable/drug therapy
MH  - Angioplasty, Balloon, Coronary/*adverse effects
MH  - Anticoagulants/*adverse effects/therapeutic use
MH  - Female
MH  - Hemorrhage/*chemically induced/prevention & control
MH  - Heparin/*adverse effects/therapeutic use
MH  - Hirudins/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*adverse effects/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Postoperative Complications
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2008/07/08 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/08 09:00
PHST- 2008/01/16 00:00 [received]
PHST- 2008/03/07 00:00 [revised]
PHST- 2008/03/07 00:00 [accepted]
PHST- 2008/07/08 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/08 09:00 [entrez]
AID - S0002-9149(08)00527-4 [pii]
AID - 10.1016/j.amjcard.2008.03.030 [doi]
PST - ppublish
SO  - Am J Cardiol. 2008 Jul 15;102(2):160-4. doi: 10.1016/j.amjcard.2008.03.030. Epub 
      2008 May 28.