PMID- 22668505 OWN - NLM STAT- MEDLINE DCOM- 20130404 LR - 20181201 IS - 1969-6213 (Electronic) IS - 1774-024X (Linking) VI - 8 IP - 4 DP - 2012 Aug TI - Bivalirudin versus unfractionated heparin in percutaneous coronary interventions of patients having received initial fondaparinux treatment: a propensity matched study. PG - 486-92 LID - 20110726_01 [pii] LID - 10.4244/EIJV8I4A76 [doi] AB - AIMS: Fondaparinux is an indirect, Factor Xa inhibitor that requires co-administration of another anticoagulant with anti-Factor IIa activity for percutaneous coronary intervention (PCI) per guideline recommendations. In this setting, the use of bivalirudin, a direct Factor IIa inhibitor, is not well established. METHODS AND RESULTS: Using the Premier hospital database, we identified 971 patients who underwent elective or urgent PCI after receiving fondaparinux as the initial anticoagulant. They were treated with either bivalirudin +/- glycoprotein IIb/IIIa inhibitor (GPI) (Group A=618) or unfractionated heparin (UFH) +/- GPI (Group B=353) during PCI. A 2:1 propensity score matching (PSM) process was performed to control for patient and hospital level characteristics. The primary endpoints were to determine in-hospital death, bleeding and post-PCI length of stay (LOS) between treatment groups. After PSM, 512 matched patients were analysed (Group A=348 and Group B=174). In-hospital death was 1.4% in Group A vs. 2.9% in Group B (p=0.26). Clinically apparent bleeding occurred in 4.0% of Group A vs. 9.2% of Group B patients (p<0.02). Clinically apparent bleeding requiring transfusion was lower in Group A patients (0.6% vs. 2.9%; p=0.04). Post-PCI LOS was 1.9 +/- 3.8 days for Group A and 2.4 +/- 5.8 days for Group B (p=0.36). GPI use during PCI occurred in 9.2% of Group A vs. 44.8% of Group B patients (p<0.0001). CONCLUSIONS: After initial administration of fondaparinux, a bivalirudin-based strategy for PCI is associated with significantly reduced bleeding, with similar mortality and post-PCI LOS when compared with an UFH-based strategy. FAU - Hamon, Martial AU - Hamon M AD - University of Caen, France. hamon-m@chu-caen.fr FAU - Rao, Sunil V AU - Rao SV FAU - Steg, Gabriel AU - Steg G FAU - Valgimigli, Marco AU - Valgimigli M FAU - Verheugt, Freek AU - Verheugt F FAU - Marso, Steven AU - Marso S FAU - Gershlick, Anthony AU - Gershlick A FAU - Wang, Yamei AU - Wang Y FAU - Deliargyris, Efthymios AU - Deliargyris E LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - France TA - EuroIntervention JT - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology JID - 101251040 RN - 0 (Anticoagulants) RN - 0 (Antithrombins) RN - 0 (Hirudins) RN - 0 (Peptide Fragments) RN - 0 (Polysaccharides) RN - 0 (Recombinant Proteins) RN - 9005-49-6 (Heparin) RN - J177FOW5JL (Fondaparinux) RN - TN9BEX005G (bivalirudin) SB - IM MH - Aged MH - Anticoagulants/therapeutic use MH - Antithrombins/therapeutic use MH - Drug Therapy, Combination MH - Female MH - Follow-Up Studies MH - Fondaparinux MH - Hemorrhage/epidemiology MH - Heparin/*therapeutic use MH - Hirudins MH - Hospital Mortality MH - Humans MH - Incidence MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Myocardial Infarction/*mortality/*therapy MH - Peptide Fragments/*therapeutic use MH - Percutaneous Coronary Intervention/*methods MH - Polysaccharides/*therapeutic use MH - Prospective Studies MH - Recombinant Proteins/therapeutic use MH - Retrospective Studies MH - Treatment Outcome EDAT- 2012/06/07 06:00 MHDA- 2013/04/05 06:00 CRDT- 2012/06/07 06:00 PHST- 2012/06/07 06:00 [entrez] PHST- 2012/06/07 06:00 [pubmed] PHST- 2013/04/05 06:00 [medline] AID - 20110726_01 [pii] AID - 10.4244/EIJV8I4A76 [doi] PST - ppublish SO - EuroIntervention. 2012 Aug;8(4):486-92. doi: 10.4244/EIJV8I4A76.