PMID- 20102938
OWN - NLM
STAT- MEDLINE
DCOM- 20100301
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 105
IP  - 3
DP  - 2010 Feb 1
TI  - Safety and in-hospital outcomes of bivalirudin use in dialysis patients 
      undergoing percutaneous coronary intervention.
PG  - 297-301
LID - 10.1016/j.amjcard.2009.09.030 [doi]
AB  - Chronic dialysis-dependent patients undergoing percutaneous coronary intervention 
      (PCI) are at a greater risk of bleeding and ischemic events. Bivalirudin has been 
      associated with fewer bleeding complications than unfractionated heparin (UFH) in 
      patients undergoing PCI in various clinical settings. These studies, however, 
      have systematically excluded patients dependent on chronic dialysis. We sought to 
      assess the safety, bleeding rates, and in-hospital outcomes of bivalirudin use 
      compared to UFH use alone in patients requiring dialysis and undergoing PCI. A 
      retrospective analysis of 396 dialysis-dependent patients undergoing PCI from 
      January 2000 to March 2009 was performed. Patients treated with a dose-adjusted 
      bivalirudin regimen (n = 267) were compared to those treated with UFH alone (n = 
      129). The primary end point of major bleeding (hematocrit decrease > or = 15%, 
      gastrointestinal or intracerebral bleeding) and the composite end point of 
      in-hospital death, nonfatal Q-wave myocardial infarction, and urgent target 
      vessel revascularization were compared between groups. The baseline 
      characteristics were similar between the 2 groups, except for the proportion of 
      men and nonsmokers and body mass index, which were greater in patients treated 
      with bivalirudin. The rate of major bleeding was similar between the bivalirudin 
      and UFH groups (3.4% vs 3.1%, respectively, p = 0.9). The rate of the composite 
      end point (death, Q-wave myocardial infarction, urgent target vessel 
      revascularization) was not significantly different between the 2 groups (1.8% for 
      bivalirudin vs 0.8% for UFH group, p = 0.7). After adjustment, bivalirudin use 
      was not associated with major bleeding (odds ratio 1.23, 95% confidence interval 
      0.37 to 4.13, p = 0.7). In conclusion, a dose-adjusted bivalirudin 
      anticoagulation regimen for patients requiring chronic dialysis undergoing PCI 
      seems to be as safe and as effective as UFH use alone. These results do not 
      suggest the superiority of bivalirudin over UFH.
CI  - Copyright 2010 Elsevier Inc. All rights reserved.
FAU - Delhaye, Cedric
AU  - Delhaye C
AD  - Department of Internal Medicine, Division of Cardiology, Washington Hospital 
      Center, Washington, District of Columbia, USA.
FAU - Maluenda, Gabriel
AU  - Maluenda G
FAU - Wakabayashi, Kohei
AU  - Wakabayashi K
FAU - Ben-Dor, Itsik
AU  - Ben-Dor I
FAU - Collins, Sara D
AU  - Collins SD
FAU - Syed, Asmir I
AU  - Syed AI
FAU - Gonzalez, Manuel A
AU  - Gonzalez MA
FAU - Gaglia, Michael A
AU  - Gaglia MA
FAU - Torguson, Rebecca
AU  - Torguson R
FAU - Xue, Zhenyi
AU  - Xue Z
FAU - Suddath, William O
AU  - Suddath WO
FAU - Satler, Lowell F
AU  - Satler LF
FAU - Kent, Kenneth M
AU  - Kent KM
FAU - Lindsay, Joseph
AU  - Lindsay J
FAU - Pichard, Augusto D
AU  - Pichard AD
FAU - Waksman, Ron
AU  - Waksman R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20091222
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  - Drug Therapy, Combination
MH  - Female
MH  - Hemorrhage/*prevention & control
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - *Inpatients
MH  - Kidney Failure, Chronic/therapy
MH  - Male
MH  - Peptide Fragments/*therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - *Renal Dialysis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2010/01/28 06:00
MHDA- 2010/03/02 06:00
CRDT- 2010/01/28 06:00
PHST- 2009/08/24 00:00 [received]
PHST- 2009/09/16 00:00 [revised]
PHST- 2009/09/16 00:00 [accepted]
PHST- 2010/01/28 06:00 [entrez]
PHST- 2010/01/28 06:00 [pubmed]
PHST- 2010/03/02 06:00 [medline]
AID - S0002-9149(09)02401-1 [pii]
AID - 10.1016/j.amjcard.2009.09.030 [doi]
PST - ppublish
SO  - Am J Cardiol. 2010 Feb 1;105(3):297-301. doi: 10.1016/j.amjcard.2009.09.030. Epub 
      2009 Dec 22.