PMID- 19595396
OWN - NLM
STAT- MEDLINE
DCOM- 20090924
LR  - 20161125
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 10
IP  - 3
DP  - 2009 Jul-Sep
TI  - Head-to-head comparison of bivalirudin versus heparin without glycoprotein 
      IIb/IIIa inhibitors in patients with acute myocardial infarction undergoing 
      primary angioplasty.
PG  - 156-61
LID - 10.1016/j.carrev.2008.12.005 [doi]
AB  - BACKGROUND: In patients receiving primary percutaneous coronary intervention for 
      ST elevation myocardial infarction (STEMI), bivalirudin with provisional 
      glycoprotein (GP) IIb/IIIa inhibitors has been demonstrated to be noninferior to 
      heparin plus systematic GP IIb/IIIa inhibitors in preventing recurrent ischemic 
      events with improved safety in terms of bleeding. However, no study has been 
      performed comparing head-to-head bivalirudin with heparin without GP IIb/IIIa 
      inhibitor infusion in STEMI patients. METHODS: We retrospectively studied 899 
      consecutive patients who presented with STEMI treated by primary angioplasty 
      within 12 h after symptoms. Among them, 566 received bivalirudin and 333 received 
      unfractionated heparin. Their in-hospital outcome in terms of efficacy and safety 
      was assessed using rates of major adverse cardiac events (MACE) and major 
      bleeding, respectively. Clinical, angiographic and procedural characteristics 
      were well matched between the two groups. RESULTS: Patients in the heparin group 
      more frequently required intra-aortic balloon pumping (6.6% vs. 3.6%, P=.037). 
      Regarding the safety end point, the MACE rate, including death, ischemic stroke 
      and urgent repeated revascularization, was low and similar in both groups (2.7% 
      bivalirudin vs. 1.2% heparin, P=.15). The rate of major bleeding, including major 
      hematoma, gastrointestinal bleeding and hematocrit drop >15% during 
      hospitalization, was high and identical in the two groups (4.1% bivalirudin vs. 
      4.2% heparin, P=.92). CONCLUSION: This study suggests that bivalirudin and 
      heparin present similar safety and efficacy profiles when used without GP 
      IIb/IIIa inhibitor infusion during primary angioplasty.
FAU - Bonello, Laurent
AU  - Bonello L
AD  - Department of Internal Medicine, Division of Cardiology, Washington Hospital 
      Center, Washington, DC 20010, USA.
FAU - de Labriolle, Axel
AU  - de Labriolle A
FAU - Roy, Probal
AU  - Roy P
FAU - Steinberg, Daniel H
AU  - Steinberg DH
FAU - Pinto Slottow, Tina L
AU  - Pinto Slottow TL
FAU - Xue, Zhenyi
AU  - Xue Z
FAU - Kaneshige, Kimberly
AU  - Kaneshige K
FAU - Torguson, Rebecca
AU  - Torguson R
FAU - Suddath, William O
AU  - Suddath WO
FAU - Satler, Lowell F
AU  - Satler LF
FAU - Kent, Kenneth M
AU  - Kent KM
FAU - Pichard, Augusto D
AU  - Pichard AD
FAU - Waksman, Ron
AU  - Waksman R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
RN  - 0 (Fibrinolytic Agents)
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  - Aged
MH  - *Angioplasty, Balloon, Coronary/adverse effects/mortality
MH  - Brain Ischemia/etiology/prevention & control
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heart Diseases/etiology/prevention & control
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Intra-Aortic Balloon Pumping
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/*therapy
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stroke/etiology/prevention & control
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2009/07/15 09:00
MHDA- 2009/09/25 06:00
CRDT- 2009/07/15 09:00
PHST- 2008/12/05 00:00 [received]
PHST- 2008/12/05 00:00 [accepted]
PHST- 2009/07/15 09:00 [entrez]
PHST- 2009/07/15 09:00 [pubmed]
PHST- 2009/09/25 06:00 [medline]
AID - S1553-8389(08)00300-X [pii]
AID - 10.1016/j.carrev.2008.12.005 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2009 Jul-Sep;10(3):156-61. doi: 
      10.1016/j.carrev.2008.12.005.