PMID- 22980964
OWN - NLM
STAT- MEDLINE
DCOM- 20130416
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 110
IP  - 12
DP  - 2012 Dec 15
TI  - Benefit of bivalirudin versus heparin after transradial and transfemoral 
      percutaneous coronary intervention.
PG  - 1742-8
LID - S0002-9149(12)01935-2 [pii]
LID - 10.1016/j.amjcard.2012.07.043 [doi]
AB  - Bivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding 
      and provide a better safety profile compared to unfractionated heparin (UFH) in 
      patients undergoing percutaneous coronary intervention (PCI) through transfemoral 
      access. Data pertaining to the clinical benefit of bivalirudin compared to UFH 
      monotherapy in patients undergoing transradial PCI are lacking. The present study 
      sought to compare the in-hospital net clinical adverse events, including death, 
      myocardial infarction, target vessel revascularization, and bleeding, for these 2 
      antithrombotic regimens for all patients at a tertiary care, high-volume radial 
      center. From April 2009 to February 2011, all patients treated with bivalirudin 
      were matched by access site to those receiving UFH. The patients in the 
      bivalirudin group (n = 125) were older (72 +/- 13 years vs 66 +/- 11 years; p 
      <0.0001), more often had chronic kidney disease (51% vs 30%; p = 0.0012), and 
      more often underwent primary PCI (30% vs 14%, p <0.0037) than the UFH-treated 
      patients (n = 125). A radial approach was used in 71% of both groups. The 
      baseline bleeding risk according to Mehran's score was similar in both groups (14 
      +/- 9 vs 15 +/- 8, p = 0.48). In-hospital mortality was 2% in both groups (p = 1.00). 
      No difference in net clinical adverse events or ischemic or bleeding 
      complications was detected between the 2 groups. Bivalirudin reduced both 
      ischemic and bleeding events in femoral-treated patients, but no such clinical 
      benefit was observed in the radial-treated patients. In conclusion, as 
      periprocedural PCI bleeding avoidance strategies have become paramount to 
      optimize the clinical benefit, the interaction between bivalirudin and radial 
      approach deserves additional investigation.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - MacHaalany, Jimmy
AU  - MacHaalany J
AD  - Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
FAU - Abdelaal, Eltigani
AU  - Abdelaal E
FAU - Bataille, Yoann
AU  - Bataille Y
FAU - Plourde, Guillaume
AU  - Plourde G
FAU - Duranleau-Gagnon, Pierre
AU  - Duranleau-Gagnon P
FAU - Larose, Eric
AU  - Larose E
FAU - Dery, Jean-Pierre
AU  - Dery JP
FAU - Barbeau, Gerald
AU  - Barbeau G
FAU - Rinfret, Stephane
AU  - Rinfret S
FAU - Rodes-Cabau, Josep
AU  - Rodes-Cabau J
FAU - De Larochelliere, Robert
AU  - De Larochelliere R
FAU - Roy, Louis
AU  - Roy L
FAU - Costerousse, Olivier
AU  - Costerousse O
FAU - Bertrand, Olivier F
AU  - Bertrand OF
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20120914
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
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
MH  - Aged
MH  - Anticoagulants/*adverse effects/therapeutic use
MH  - Antithrombins/adverse effects/therapeutic use
MH  - Female
MH  - Hemorrhage/*etiology
MH  - Heparin/*adverse effects/therapeutic use
MH  - Hirudins/*adverse effects
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*adverse effects/therapeutic use
MH  - Percutaneous Coronary Intervention
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Tertiary Healthcare
MH  - Treatment Outcome
EDAT- 2012/09/18 06:00
MHDA- 2013/04/17 06:00
CRDT- 2012/09/18 06:00
PHST- 2012/06/30 00:00 [received]
PHST- 2012/07/30 00:00 [revised]
PHST- 2012/07/30 00:00 [accepted]
PHST- 2012/09/18 06:00 [entrez]
PHST- 2012/09/18 06:00 [pubmed]
PHST- 2013/04/17 06:00 [medline]
AID - S0002-9149(12)01935-2 [pii]
AID - 10.1016/j.amjcard.2012.07.043 [doi]
PST - ppublish
SO  - Am J Cardiol. 2012 Dec 15;110(12):1742-8. doi: 10.1016/j.amjcard.2012.07.043. 
      Epub 2012 Sep 14.