PMID- 21972401
OWN - NLM
STAT- MEDLINE
DCOM- 20120208
LR  - 20161125
IS  - 1941-7632 (Electronic)
IS  - 1941-7640 (Linking)
VI  - 4
IP  - 5
DP  - 2011 Oct 1
TI  - Bleeding risk comparing targeted low-dose heparin with bivalirudin in patients 
      undergoing percutaneous coronary intervention: results from a propensity 
      score-matched analysis of the Evaluation of Drug-Eluting Stents and Ischemic 
      Events (EVENT) registry.
PG  - 463-73
LID - 10.1161/CIRCINTERVENTIONS.111.961912 [doi]
AB  - BACKGROUND: Prior randomized trials have shown reduced bleeding with bivalirudin 
      compared with unfractionated heparin (UFH) in patients undergoing percutaneous 
      coronary intervention (PCI). However, it is not known if this benefit is also 
      present when UFH doses are more tightly controlled (as measured by activated 
      clotting time, ACT). METHODS AND RESULTS: Patients enrolled in the EVENT 
      (Evaluation of Drug-Eluting Stents and Ischemic Events) registry, were divided 
      into 3 groups, based on the antithrombotic drug used during PCI (UFH monotherapy, 
      UFH+glycoprotein IIb-IIIa receptor inhibitor [GPI], or bivalirudin alone). 
      Propensity score matching was used to adjust for measured covariates (89 
      variables) and to compare bivalirudin versus UFH monotherapy and bivalirudin 
      versus UFH+GPI groups. The UFH groups were stratified based on ACT achieved 
      (optimal ACT defined as 250-300 for UFH monotherapy and 200-250 when GPI was also 
      used). The primary bleeding outcome was in-hospital composite bleeding, defined 
      as events of access site bleeding, Thrombolysis In Myocardial Infarction 
      major/minor bleeding, or transfusion. Primary (in-hospital death/myocardial 
      infarction) and secondary ischemic outcomes (death/MI/unplanned repeat 
      revascularization at 12 months) were also evaluated. Propensity score matching 
      yielded 3022 patients for the UFH monotherapy versus bivalirudin comparison and 
      3520 patients for the UFH+GPI versus bivalirudin comparison. Bivalirudin use was 
      associated with numerically lower bleeding rates at all categories of achieved 
      ACT when compared with UFH (low, optimal, high ACT: 2.5% versus 4.7%, 1.9% versus 
      6.0%, 3.1% versus 4.8%, respectively) or heparin+GPI groups (low, optimal, high 
      ACT: 0.0% versus 2.7%, 2.7% versus 5.2%, 2.4% versus 6.1%, respectively) and was 
      not associated with any statistically significant increase in either primary or 
      secondary ischemic outcomes. CONCLUSIONS: Among unselected patients undergoing 
      PCI, bivalirudin use during PCI was associated with a lower risk of bleeding at 
      all comparator ACT levels without an increase in ischemic outcomes.
FAU - Bangalore, Sripal
AU  - Bangalore S
AD  - Department of Medicine, Division of Cardiovascular Medicine, New York University 
      School of Medicine, 530 First Avenue, New York, NY 10016, USA. 
      sripalbangalore@gmail.com
FAU - Cohen, David J
AU  - Cohen DJ
FAU - Kleiman, Neal S
AU  - Kleiman NS
FAU - Regev-Beinart, Tal
AU  - Regev-Beinart T
FAU - Rao, Sunil V
AU  - Rao SV
FAU - Pencina, Michael J
AU  - Pencina MJ
FAU - Mauri, Laura
AU  - Mauri L
CN  - EVENT Registry Investigators, Boston, MA
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111004
PL  - United States
TA  - Circ Cardiovasc Interv
JT  - Circulation. Cardiovascular interventions
JID - 101499602
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/mortality/physiopathology/*therapy
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Drug Dosage Calculations
MH  - Female
MH  - *Fibrinolytic Agents/administration & dosage/adverse effects/pharmacology
MH  - Hemorrhage
MH  - *Heparin/administration & dosage/adverse effects
MH  - *Hirudins/administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Peptide Fragments/administration & dosage/adverse effects
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - Propensity Score
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Risk
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Whole Blood Coagulation Time
EDAT- 2011/10/06 06:00
MHDA- 2012/02/09 06:00
CRDT- 2011/10/06 06:00
PHST- 2011/10/06 06:00 [entrez]
PHST- 2011/10/06 06:00 [pubmed]
PHST- 2012/02/09 06:00 [medline]
AID - CIRCINTERVENTIONS.111.961912 [pii]
AID - 10.1161/CIRCINTERVENTIONS.111.961912 [doi]
PST - ppublish
SO  - Circ Cardiovasc Interv. 2011 Oct 1;4(5):463-73. doi: 
      10.1161/CIRCINTERVENTIONS.111.961912. Epub 2011 Oct 4.