PMID- 19736157
OWN - NLM
STAT- MEDLINE
DCOM- 20091006
LR  - 20191111
IS  - 1774-024X (Print)
IS  - 1774-024X (Linking)
VI  - 5
IP  - 3
DP  - 2009 Aug
TI  - A comparison of anticoagulation with bivalirudin and provisional GPIIb/IIIa 
      inhibition with unfractionated heparin and mandatory GPIIb/IIIa inhibition during 
      percutaneous coronary intervention in relation to platelet activation and the 
      inhibition of coagulation.
PG  - 330-5
LID - V5I3A52 [pii]
AB  - AIMS: Our study sought to evaluate mechanisms of the current strategies for 
      optimal anticoagulation during percutaneous coronary intervention (PCI). METHODS 
      AND RESULTS: Thirty-two high risk acute coronary syndrome patients were 
      randomised to bivalirudin and provisional GPIIb/IIIa inhibition (GPIIb/IIIa) or 
      unfractionated heparin (UFH) and mandatory GPIIb/IIIa. Flow cytometric 
      measurements immediately after anticoagulation showed that, unlike UFH, 
      bivalirudin did not activate platelets as indicated by P-selectin expression and 
      fibrinogen binding while decreasing platelet-monocyte aggregates and monocyte 
      expression of tissue factor. UFH released tissue factor pathway inhibitor (TFPI) 
      during and immediately after PCI while bivalirudin (irrespective of GP IIb/IIIa) 
      did not. Lower levels of TFPI with bivalirudin were seen during and immediately 
      after PCI (P<0.01). Thrombin generation as indicated by prothrombin fragment F 
      1+2 levels was reduced during PCI in the UFH group (P<0.01) but not with 
      bivalirudin. Soluble CD40 ligand is associated with thrombosis and levels were 
      higher in the bivalirudin group irrespective of GPIIb/IIIa at the same stages 
      (P<0.05). CONCLUSIONS: Bivalirudin has some early advantages on platelet 
      activation when compared to UFH. However, there are significant limitations in 
      its mechanism of action, particularly a lack of release of tissue factor pathway 
      inhibitor.
FAU - Ray, Michael J
AU  - Ray MJ
AD  - Pathology Queensland, The Prince Charles Laboratory Group, The Prince Charles 
      Hospital, Queensland, Australia. michael_ray@health.qld.gov.au
FAU - Juneja, Manjeet
AU  - Juneja M
FAU - Bett, Nicholas
AU  - Bett N
FAU - Walters, Darren L
AU  - Walters DL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - France
TA  - EuroIntervention
JT  - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on 
      Interventional Cardiology of the European Society of Cardiology
JID - 101251040
RN  - 0 (Anticoagulants)
RN  - 0 (Biomarkers)
RN  - 0 (Hirudins)
RN  - 0 (Lipoproteins)
RN  - 0 (Membrane Glycoproteins)
RN  - 0 (P-selectin ligand protein)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 0 (lipoprotein-associated coagulation inhibitor)
RN  - 0 (prothrombin fragment 1.2)
RN  - 147205-72-9 (CD40 Ligand)
RN  - 9001-26-7 (Prothrombin)
RN  - 9001-32-5 (Fibrinogen)
RN  - 9005-49-6 (Heparin)
RN  - 9035-58-9 (Thromboplastin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/blood/drug therapy/*therapy
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary/adverse effects
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Aspirin/therapeutic use
MH  - Biomarkers/blood
MH  - Blood Coagulation/*drug effects
MH  - CD40 Ligand/blood
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fibrinogen/metabolism
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Lipoproteins/blood
MH  - Male
MH  - Membrane Glycoproteins/blood
MH  - Middle Aged
MH  - Monocytes/drug effects/metabolism
MH  - Peptide Fragments/adverse effects/blood/*therapeutic use
MH  - Platelet Activation/*drug effects
MH  - Platelet Adhesiveness/drug effects
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors
MH  - Prothrombin
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Thromboplastin/metabolism
MH  - Thrombosis/etiology/prevention & control
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2009/09/09 06:00
MHDA- 2009/10/07 06:00
CRDT- 2009/09/09 06:00
PHST- 2009/09/09 06:00 [entrez]
PHST- 2009/09/09 06:00 [pubmed]
PHST- 2009/10/07 06:00 [medline]
AID - V5I3A52 [pii]
AID - 10.4244/v5i3a52 [doi]
PST - ppublish
SO  - EuroIntervention. 2009 Aug;5(3):330-5. doi: 10.4244/v5i3a52.