PMID- 20102912
OWN - NLM
STAT- MEDLINE
DCOM- 20100225
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 105
IP  - 2
DP  - 2010 Jan 15
TI  - Bleeding after percutaneous coronary intervention with Bivalirudin or 
      unfractionated Heparin and one-year mortality.
PG  - 163-7
LID - 10.1016/j.amjcard.2009.08.668 [doi]
AB  - Compared to unfractionated heparin (UFH), bivalirudin decreases bleeding during 
      percutaneous coronary interventions (PCIs). We sought to investigate the 
      association between periprocedural bleeding and 1-year mortality as a function of 
      antithrombotic therapy with bivalirudin or UFH. This analysis of the association 
      between bleeding with bivalirudin or UFH and 1-year mortality included the 4,570 
      patients with negative biomarkers enrolled in the Intracoronary Stenting and 
      Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 3) 
      trial. Major or minor bleeding occurred in 555 patients (12.1%): 225 patients 
      treated with bivalirudin (9.8%) and 330 patients treated with UFH (14.5%, p 
      <0.001). There were 82 deaths (1.8%) within the first year after PCI: 29 deaths 
      occurred in patients who had bled, and 53 deaths occurred in patients who had not 
      bled (Kaplan-Meier estimates of 1-year mortality 5.2% and 1.3%, odds ratio 4.12, 
      95% confidence interval 2.59 to 6.54, p <0.001). One year after PCI, there were 
      15 deaths in patients who bled with bivalirudin versus 14 deaths in patients who 
      bled with UFH (Kaplan-Meier estimates of 1-year mortality 6.7% vs 4.2%, odds 
      ratio 1.61, 95% confidence interval 0.76 to 3.40, p = 0.20). Major bleeding 
      occurred in 70 patients (3.0%) treated with bivalirudin and 104 patients treated 
      with UFH (4.5%, p = 0.008). One-year mortality was 11.4% (n = 8) in patients with 
      major bleeding with bivalirudin versus 4.8% (n = 5) in patients with major 
      bleeding with UFH (p = 0.10). In conclusion, these data suggest that in patients 
      with negative biomarkers undergoing PCI, bivalirudin decreases bleeding after PCI 
      compared to UFH, without affecting 1-year mortality in those who had bled.
CI  - Copyright 2010 Elsevier Inc. All rights reserved.
FAU - Ndrepepa, Gjin
AU  - Ndrepepa G
AD  - Deutsches Herzzentrum, Technische Universitat, Munich, Germany. 
      ndrepepa@dhm.mhn.de
FAU - Schulz, Stefanie
AU  - Schulz S
FAU - Keta, Dritan
AU  - Keta D
FAU - Mehilli, Julinda
AU  - Mehilli J
FAU - Birkmeier, Anette
AU  - Birkmeier A
FAU - Massberg, Steffen
AU  - Massberg S
FAU - Laugwitz, Karl-Ludwig
AU  - Laugwitz KL
FAU - Neumann, Franz-Josef
AU  - Neumann FJ
FAU - Seyfarth, Melchior
AU  - Seyfarth M
FAU - Berger, Peter B
AU  - Berger PB
FAU - Schomig, Albert
AU  - Schomig A
FAU - Kastrati, Adnan
AU  - Kastrati A
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20091114
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 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*therapeutic use
MH  - Cohort Studies
MH  - Coronary Artery Disease/mortality/*therapy
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*therapeutic use
MH  - Postoperative Hemorrhage/*etiology/mortality
MH  - Recombinant Proteins/therapeutic use
MH  - Risk Factors
MH  - Stents
MH  - Treatment Outcome
EDAT- 2010/01/28 06:00
MHDA- 2010/02/26 06:00
CRDT- 2010/01/28 06:00
PHST- 2009/08/03 00:00 [received]
PHST- 2009/08/25 00:00 [revised]
PHST- 2009/08/25 00:00 [accepted]
PHST- 2010/01/28 06:00 [entrez]
PHST- 2010/01/28 06:00 [pubmed]
PHST- 2010/02/26 06:00 [medline]
AID - S0002-9149(09)02312-1 [pii]
AID - 10.1016/j.amjcard.2009.08.668 [doi]
PST - ppublish
SO  - Am J Cardiol. 2010 Jan 15;105(2):163-7. doi: 10.1016/j.amjcard.2009.08.668. Epub 
      2009 Nov 14.