PMID- 19543084
OWN - NLM
STAT- MEDLINE
DCOM- 20090917
LR  - 20161125
IS  - 1473-5830 (Electronic)
IS  - 0954-6928 (Linking)
VI  - 20
IP  - 5
DP  - 2009 Aug
TI  - Safety and efficacy of a prolonged bivalirudin infusion after urgent and complex 
      percutaneous coronary interventions: a descriptive study.
PG  - 348-53
LID - 10.1097/MCA.0b013e32832cff08 [doi]
AB  - OBJECTIVE: Bivalirudin, a direct thrombin inhibitor, provides similar ischemic 
      outcomes with significantly less major bleeding compared with unfractionated 
      heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) in patients undergoing 
      percutaneous coronary interventions (PCI). Although the approved labeling for 
      bivalirudin allows for low-dose prolonged postprocedure administration, this 
      practice is not routine. Therefore, we sought to evaluate the safety and efficacy 
      of longer post-PCI infusion. METHODS: From our database, we retrospectively 
      compared two groups of patients with acute coronary syndrome undergoing complex 
      PCI, one group treated with UFH+GPI (n = 59) and another with a periprocedural 
      and post-PCI bivalirudin infusion for 4 h (n = 50). Endpoints included 
      periprocedural myocardial infarction (MI), 30-day major adverse cardiac events, 
      and in-hospital major and minor bleeding. RESULTS: There were no significant 
      differences in the baseline and procedural characteristics of the two groups; 
      most patients (approximately 90%) had complex coronary lesions (the American 
      College of Cardiology/American Heart Association type B2/C). There was no 
      significant difference in the rates of periprocedural MI (11.9 vs. 8.0%, P = NS) 
      or 30-day major adverse cardiac events (8.5 vs. 6.0%, P = NS) among patients 
      treated with UFH+GPI or bivalirudin. However, patients who received bivalirudin 
      had significantly lower rates of minor bleeding (20.3 vs. 4.0%, P<0.05), and a 
      trend toward significantly less major bleeding (8.5 vs. 4.0%, P = 0.07). When we 
      compared the group treated with a prolonged bivalirudin infusion with a 
      historical group treated with peri-PCI-only bivalirudin infusion, we observed in 
      the latter an increased incidence of periprocedural MI and a comparable incidence 
      of bleeding. CONCLUSION: A prolonged bivalirudin infusion after urgent PCI seems 
      effective in protecting myocardium without increasing bleeding rates, and 
      represents an attractive alternative to the standard pharmacological treatment of 
      UFH+GPI in the catheterization laboratory.
FAU - Cortese, Bernardo
AU  - Cortese B
AD  - Interventional Cardiology Unit, Ospedale della Misericordia, Grosseto, Italy. 
      bcortese@gmail.com
FAU - Micheli, Andrea
AU  - Micheli A
FAU - Picchi, Andrea
AU  - Picchi A
FAU - Bandinelli, Loria
AU  - Bandinelli L
FAU - Brizi, Maria Gina
AU  - Brizi MG
FAU - Severi, Silva
AU  - Severi S
FAU - Limbruno, Ugo
AU  - Limbruno U
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Coron Artery Dis
JT  - Coronary artery disease
JID - 9011445
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  - Acute Coronary Syndrome/drug therapy/*therapy
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary/adverse effects
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cardiovascular Diseases/etiology/*prevention & control
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Female
MH  - Hemorrhage/etiology
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hirudins/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/etiology/prevention & control
MH  - Peptide Fragments/*administration & dosage/adverse effects
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2009/06/23 09:00
MHDA- 2009/09/18 06:00
CRDT- 2009/06/23 09:00
PHST- 2009/06/23 09:00 [entrez]
PHST- 2009/06/23 09:00 [pubmed]
PHST- 2009/09/18 06:00 [medline]
AID - 10.1097/MCA.0b013e32832cff08 [doi]
PST - ppublish
SO  - Coron Artery Dis. 2009 Aug;20(5):348-53. doi: 10.1097/MCA.0b013e32832cff08.