PMID- 22581418 OWN - NLM STAT- MEDLINE DCOM- 20140604 LR - 20161125 IS - 1522-726X (Electronic) IS - 1522-1946 (Linking) VI - 82 IP - 4 DP - 2013 Oct 1 TI - Safety of bivalirudin in percutaneous coronary intervention following thrombolytic therapy. PG - 614-20 LID - 10.1002/ccd.24478 [doi] AB - OBJECTIVES: This study was undertaken to evaluate the safety of bivalirudin (BIV) use during percutaneous coronary intervention (PCI), following thrombolytic therapy in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: BIV has emerged as a safer anticoagulant than unfractionated heparin (UFH) during primary PCI; however, its use in patients who receive thrombolytic therapy has not been established. METHODS: A consecutive series of 104 patients who presented with STEMI treated with full-dose thrombolytics and who subsequently received PCI within 6 hr was identified and analyzed. BIV use was compared with UFH for in-hospital bleeding and ischemic events. The primary end points were the rate of major bleeding and the rate of net adverse clinical events as defined in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. The study cohort consisted of 104 patients, of whom 47 (45%) received BIV and 57 (55%) received UFH. RESULTS: Patients on BIV were more frequently preloaded with clopidogrel, while intraprocedural glycoprotein IIb/IIIa inhibitors were used only in UFH patients. In-hospital death, ischemic events, and thrombolysis in myocardial infarction major bleeding occurred more frequently in patients treated with UFH. The net adverse clinical events rate was lower in the intraprocedural BIV group (3 [6.4%] vs. 12 [21.1%] UFH, P = 0.034). CONCLUSIONS: The use of BIV in patients presenting with STEMI who were pretreated with thrombolytic therapy and who subsequently underwent PCI is safe and is associated with less ischemic and bleeding events when compared with UFH, and should be considered as the first line anticoagulant for these patients during PCI. CI - Copyright (c) 2012 Wiley Periodicals, Inc. FAU - Sardi, Gabriel L AU - Sardi GL AD - Division of Cardiology, MedStar Washington Hospital Center, Washington Hospital Center, Washington, District of Columbia. FAU - Lindsay, Joseph AU - Lindsay J FAU - Waksman, Ron AU - Waksman R LA - eng PT - Journal Article DEP - 20130704 PL - United States TA - Catheter Cardiovasc Interv JT - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JID - 100884139 RN - 0 (Anticoagulants) RN - 0 (Antithrombins) RN - 0 (Hirudins) RN - 0 (Peptide Fragments) RN - 0 (Recombinant Proteins) RN - 9005-49-6 (Heparin) RN - TN9BEX005G (bivalirudin) SB - IM CIN - Catheter Cardiovasc Interv. 2013 Oct 1;82(4):621. PMID: 24078420 MH - Adult MH - Aged MH - Anticoagulants/therapeutic use MH - Antithrombins/adverse effects/*therapeutic use MH - Combined Modality Therapy MH - Coronary Thrombosis/diagnosis/mortality/*therapy MH - Female MH - Hemorrhage/chemically induced MH - Heparin/therapeutic use MH - Hirudins/adverse effects MH - Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/diagnosis/mortality/*therapy MH - Patient Selection MH - Peptide Fragments/adverse effects/*therapeutic use MH - *Percutaneous Coronary Intervention/adverse effects/mortality MH - Recombinant Proteins/adverse effects/therapeutic use MH - Recurrence MH - Retrospective Studies MH - Risk Factors MH - *Thrombolytic Therapy/adverse effects/mortality MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - bivalirudin OT - percutaneous coronary intervention OT - thrombolytic therapy EDAT- 2012/05/15 06:00 MHDA- 2014/06/05 06:00 CRDT- 2012/05/15 06:00 PHST- 2011/08/26 00:00 [received] PHST- 2012/05/05 00:00 [accepted] PHST- 2012/05/15 06:00 [entrez] PHST- 2012/05/15 06:00 [pubmed] PHST- 2014/06/05 06:00 [medline] AID - 10.1002/ccd.24478 [doi] PST - ppublish SO - Catheter Cardiovasc Interv. 2013 Oct 1;82(4):614-20. doi: 10.1002/ccd.24478. Epub 2013 Jul 4.