PMID- 19494400
OWN - NLM
STAT- MEDLINE
DCOM- 20090930
LR  - 20181201
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 21
IP  - 6
DP  - 2009 Jun
TI  - Frequency and outcomes of provisional glycoprotein IIb/IIIa blockade in patients 
      receiving bivalirudin during percutaneous coronary intervention.
PG  - 258-63
AB  - OBJECTIVES: This study sought to evaluate the frequency and efficacy of 
      combination of bivalirudin and provisional glycoprotein (GP) IIb/IIIa blockade 
      compared with bivalirudin monotherapy in current clinical practice of 
      percutaneous coronary intervention (PCI) with drug-eluting stents (DES). 
      BACKGROUND: Previous randomized trials have demonstrated that a strategy of 
      bivalirudin with provisional (bailout) GP IIb/IIIa inhibition was non-inferior to 
      unfractionated heparin (UFH) plus planned GP IIb/IIIa blockade for the prevention 
      of acute and long-term adverse clinical events. However, the frequency and 
      efficacy of provisional GP IIb/IIIa inhibition in addition to the full-dose 
      bivalirudin in current practice is not well established. METHODS: Using the 
      2004/2005 Cornell Angioplasty Registry, we studied 1,340 consecutive patients 
      undergoing urgent or elective PCI with periprocedural use of bivalirudin. We 
      excluded patients presenting with an acute ST-elevation myocardial infarction 
      (MI) within < or = 24 hours, hemodynamic instability/shock, thrombolytic therapy 
      within < or = 7 days, or renal insufficiency. Mean clinical follow up was 24.2 
      +/- 7.7 months. RESULTS: Of the study cohort, 1,184 patients (88.4%) received 
      bivalirudin alone and 156 (11.6%) received bivalirudin plus bailout GP IIb/IIIa 
      blockade. DES were used in 86% of PCIs. The incidence of in-hospital mortality 
      (0% vs. 0.3% p = 1.000), MI (7.1% vs. 6.6%; p = 0.864), and the combined endpoint 
      of death, stroke, emergent coronary artery bypass graft surgery (CABG)/PCI, or MI 
      (7.1% vs. 6.9%; p = 0.868) were similar in the bivalirudin-plus-bailout GP 
      IIb/IIIa inhibitor versus the bivalirudin-alone arm. There was a higher incidence 
      of bleeding complications (16.0% vs. 9.6%; p = 0.018) in the 
      bivalirudin-plus-bailout GP IIb/IIIa versus the bivalirudin-alone group. At 
      follow up, there were 4 (2.6%) deaths in the bivalirudin-plus-GP IIb/IIIa 
      inhibitor group versus 83 (7.0%) deaths in the bivalirudin-alone arm (HR 0.36, 
      95% confidence interval [CI] 0.13-0.98; p = 0.044). After multivariate Cox 
      regression analysis, bailout GP IIb/IIIa use in addition to bivalirudin was 
      associated with similar long-term survival when compared to bivalirudin 
      monotherapy (HR 0.41, 95% CI 0.15-1.12; p = 0.081). CONCLUSIONS: Provisional GP 
      IIb/IIIa use in bivalirudin-treated patients is higher in contemporary 
      non-emergent PCI practice than that seen in randomized trials and is associated 
      with similar in-hospital ischemic events, but more frequent bleeding events. 
      These data suggest that a strategy of bivalirudin monotherapy is preferable in 
      order to reduce bleeding complications, and GP IIb/IIIa blockade should be 
      reserved for patients with periprocedural complications in bivalirudin-treated 
      patients undergoing PCI.
FAU - Feldman, Dmitriy N
AU  - Feldman DN
AD  - New York Presbyterian Hospital, Weill Cornell Medical College, Greenberg Division 
      of Cardiology, 520 East 70th Street, Starr-434 Pavilion, New York, NY 10021, USA. 
      dnf9001@med.cornell.edu
FAU - Wong, S Chiu
AU  - Wong SC
FAU - Bergman, Geoffrey
AU  - Bergman G
FAU - Minutello, Robert M
AU  - Minutello RM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - 0 (Peptide Fragments)
RN  - 0 (Peptides)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - A74586SNO7 (Clopidogrel)
RN  - NA8320J834 (Eptifibatide)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
RN  - TN9BEX005G (bivalirudin)
RN  - X85G7936GV (Abciximab)
SB  - IM
CIN - J Invasive Cardiol. 2009 Jun;21(6):264-5. PMID: 19494401
MH  - Abciximab
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary/adverse effects/*methods
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Anticoagulants/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Embolism/*prevention & control
MH  - Eptifibatide
MH  - Female
MH  - Follow-Up Studies
MH  - Hirudins
MH  - Humans
MH  - Immunoglobulin Fab Fragments/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*therapeutic use
MH  - Peptides/therapeutic use
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Recombinant Proteins/therapeutic use
MH  - Registries
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Thrombosis/*prevention & control
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2009/06/06 09:00
MHDA- 2009/10/01 06:00
CRDT- 2009/06/05 09:00
PHST- 2009/06/05 09:00 [entrez]
PHST- 2009/06/06 09:00 [pubmed]
PHST- 2009/10/01 06:00 [medline]
PST - ppublish
SO  - J Invasive Cardiol. 2009 Jun;21(6):258-63.