PMID- 21029818
OWN - NLM
STAT- MEDLINE
DCOM- 20101202
LR  - 20211020
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 106
IP  - 9
DP  - 2010 Nov 1
TI  - Validation of long-term benefits of bivalirudin versus unfractionated heparin in 
      routine clinical practice after percutaneous coronary intervention.
PG  - 1234-40
LID - 10.1016/j.amjcard.2010.06.047 [doi]
AB  - Randomized controlled trials have shown improved short-term bleeding outcomes for 
      bivalirudin compared to unfractionated heparin (UFH) in patients undergoing 
      percutaneous coronary intervention (PCI) for stable angina and acute coronary 
      syndrome. This study analyzed the impact of bivalirudin-based anticoagulation 
      strategy versus UFH-based anticoagulation strategy on long-term bleeding 
      complications and major adverse cardiac events in patients undergoing PCI in 
      routine clinical practice. From September 2005 to April 2009, 3,367 consecutive 
      patients who underwent PCI for stable angina or non-ST-segment elevation acute 
      coronary syndrome at Brigham and Women's Hospital were studied. Of these 
      patients, 2,228 patients (66%) received UFH and 1,139 (34%) received bivalirudin. 
      Bleeding complication and major adverse cardiac event rates were compared at 
      discharge, 30 days, and 1 year. In a propensity-score matched analysis, 
      bivalirudin-based anticoagulation strategy was associated with lower bleeding 
      complications at 30 days (7.0% vs 13.7%, p = 0.001) and 1 year (12.7% vs 18.9%, p 
      = 0.013). Major adverse cardiac event rates were not significantly different 
      between groups at discharge, 30 days, and 1 year (6.4% vs 8.3%, p = 0.103; 9.4% 
      vs 10.9%, p = 0.449; 12.1% vs 14.8%, p = 0.235, respectively). There was no 
      difference in all-cause mortality rates between the 2 groups (0.9% vs 0.8%, p = 
      0.808, at discharge; 1.9% vs 3.6%, p = 0.112, at 30 days; 3.6% vs 5.5%, p = 
      0.195, at 1 year). In conclusion, in a real-world cohort of patients undergoing 
      PCI, bivalirudin-based anticoagulation strategy is associated with a significant 
      decrease in risk of bleeding complications after 30 days and 1 year compared to a 
      UFH-based anticoagulation strategy with no increase in risk for major adverse 
      cardiac events.
CI  - Copyright (c) 2010 Elsevier Inc. All rights reserved.
FAU - Vidi, Venkatesan D
AU  - Vidi VD
AD  - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
FAU - Matheny, Michael E
AU  - Matheny ME
FAU - Agarwal, Vikram
AU  - Agarwal V
FAU - Arora, Nipun
AU  - Arora N
FAU - Donnelly, Sharon
AU  - Donnelly S
FAU - Bangalore, Sripal
AU  - Bangalore S
FAU - Resnic, Frederic S
AU  - Resnic FS
LA  - eng
GR  - R01 LM008142/LM/NLM NIH HHS/United States
GR  - R01-LM008142/LM/NLM NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
DEP - 20100909
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  - Angina Pectoris/mortality/*therapy
MH  - Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*adverse effects/therapeutic use
MH  - Chi-Square Distribution
MH  - Combined Modality Therapy
MH  - Female
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Heparin/*adverse effects/therapeutic use
MH  - Hirudins/*adverse effects
MH  - Humans
MH  - Incidence
MH  - Logistic Models
MH  - Male
MH  - Myocardial Infarction/mortality/*therapy
MH  - Peptide Fragments/*adverse effects/therapeutic use
MH  - Propensity Score
MH  - Prospective Studies
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Risk Factors
PMC - PMC2966846
MID - NIHMS236932
EDAT- 2010/10/30 06:00
MHDA- 2010/12/14 06:00
PMCR- 2011/11/01
CRDT- 2010/10/30 06:00
PHST- 2010/03/23 00:00 [received]
PHST- 2010/06/15 00:00 [revised]
PHST- 2010/06/15 00:00 [accepted]
PHST- 2010/10/30 06:00 [entrez]
PHST- 2010/10/30 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
PHST- 2011/11/01 00:00 [pmc-release]
AID - S0002-9149(10)01364-0 [pii]
AID - 10.1016/j.amjcard.2010.06.047 [doi]
PST - ppublish
SO  - Am J Cardiol. 2010 Nov 1;106(9):1234-40. doi: 10.1016/j.amjcard.2010.06.047. Epub 
      2010 Sep 9.