PMID- 27624328
OWN - NLM
STAT- MEDLINE
DCOM- 20170505
LR  - 20181202
IS  - 1613-7671 (Electronic)
IS  - 0043-5325 (Print)
IS  - 0043-5325 (Linking)
VI  - 128
IP  - 23-24
DP  - 2016 Dec
TI  - Impact of bivalirudin on mortality and bleeding complications in acute coronary 
      syndrome patients undergoing invasive revascularization : A real world 
      experience.
PG  - 906-915
AB  - BACKGROUND: In a retrospective analysis of a prospective single center registry 
      we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, 
      UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) 
      undergoing stent implantation. RESULTS: Bivalirudin was associated with 
      tendentially reduced in-hospital minor or major bleeding rates compared to UFH 
      monotherapy (5.9 % vs. 9.4 % adjusted odds ratio (OR) 0.82, 95 % confidence 
      interval CI 0.45-1.51, p = 0.53) and compared to the pooled UFH group (5.9 % vs. 
      11.9 %, adjusted OR 0.62, 95 % CI 0.36-1.08, p = 0.09) but with significantly 
      lower bleeding hazards compared to UFH + abciximab (5.9 % vs. 16 %, adjusted OR 
      0.41, 95 % CI 0.22-0.78, p < 0.01). After 3 years of follow-up, adjusted 
      cardiovascular mortality rates were similar between all groups, particularly 
      between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95 % CI 0.58-2.16, 
      p = 0.73) and vs. UFH + abciximab (HR 0.91, 95 % CI 0.40-2.10, p = 0.83). Acute 
      or subacute stent thrombosis occurred at a rate of 0.8 % with no significant 
      differences between the groups. CONCLUSIONS: This retrospective analysis in a 
      real world situation of medium to high-risk ACS patients undergoing invasive 
      revascularization confirmed the results of most large-scale randomized trials by 
      demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but 
      with no significant differences between treatment strategies for long-term 
      all-cause and cardiovascular mortality.
FAU - Rohla, Miklos
AU  - Rohla M
AUID- ORCID: 0000-0002-8967-0806
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria. 
      miklos.rohla@meduniwien.ac.at.
FAU - Tentzeris, Ioannis
AU  - Tentzeris I
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Freynhofer, Matthias K
AU  - Freynhofer MK
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Farhan, Serdar
AU  - Farhan S
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Jarai, Rudolf
AU  - Jarai R
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Egger, Florian
AU  - Egger F
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Weiss, Thomas W
AU  - Weiss TW
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
AD  - Medical School, Sigmund Freud University, Vienna, Austria.
FAU - Wojta, Johann
AU  - Wojta J
AD  - Department of Cardiology, Medical University, Vienna, Austria.
FAU - Geppert, Alexander
AU  - Geppert A
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
FAU - Kastrati, Adnan
AU  - Kastrati A
AD  - Deutsches Herzzentrum, Technische Universitat, Munich, Germany.
FAU - Stone, Gregg W
AU  - Stone GW
AD  - Columbia University Medical Center and the Cardiovascular Research Foundation, 
      New York, USA.
FAU - Huber, Kurt
AU  - Huber K
AD  - 3rd Medical Department, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
AD  - Medical School, Sigmund Freud University, Vienna, Austria.
LA  - eng
PT  - Journal Article
DEP - 20160913
PL  - Austria
TA  - Wien Klin Wochenschr
JT  - Wiener klinische Wochenschrift
JID - 21620870R
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/*mortality/*therapy
MH  - Antithrombins/therapeutic use
MH  - Austria/epidemiology
MH  - Combined Modality Therapy/mortality/statistics & numerical data
MH  - Female
MH  - Hirudins/*administration & dosage
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*administration & dosage
MH  - Percutaneous Coronary Intervention/*mortality/statistics & numerical data
MH  - Postoperative Hemorrhage/*mortality/*prevention & control
MH  - Prevalence
MH  - Recombinant Proteins/administration & dosage
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
MH  - Treatment Outcome
PMC - PMC5161760
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Anticoagulation
OT  - Bivalirudin
OT  - Heparin
OT  - Percutaneous coronary intervention
COIS- Compliance with ethical guidelinesConflict of interestM. Rohla, I. Tentzeris, 
      M.K. Freynhofer, S. Farhan, R. Jarai, F. Egger, J. Wojta, A. Geppert declare that 
      they have no conflict of interests. T. W. Weiss received lecturing fees and 
      advisory honoraria from AstraZeneca, Daiichi Sankyo and Sanofi-Aventis. A. 
      Kastrati received lecturing fees and advisory honoraria from The Medicines 
      Company. G. W. Stone received lecturing fees and advisory honoraria from The 
      Medicines Company. Kurt Huber received lecturing fees and advisory honoraria from 
      The Medicines Company, AstraZeneca, Eli Lilly, Daiichi Sankyo and 
      Sanofi-Aventis.Ethical standardsAll studies described in this manuscript were 
      carried out with the approval of the responsible ethics committee and in 
      accordance with national law and the Helsinki Declaration of 1975 (in its current 
      revised form). Informed consent was obtained from all patients included in the 
      study.
EDAT- 2016/09/15 06:00
MHDA- 2017/05/06 06:00
PMCR- 2016/09/13
CRDT- 2016/09/15 06:00
PHST- 2016/06/18 00:00 [received]
PHST- 2016/08/05 00:00 [accepted]
PHST- 2016/09/15 06:00 [pubmed]
PHST- 2017/05/06 06:00 [medline]
PHST- 2016/09/15 06:00 [entrez]
PHST- 2016/09/13 00:00 [pmc-release]
AID - 10.1007/s00508-016-1078-6 [pii]
AID - 1078 [pii]
AID - 10.1007/s00508-016-1078-6 [doi]
PST - ppublish
SO  - Wien Klin Wochenschr. 2016 Dec;128(23-24):906-915. doi: 
      10.1007/s00508-016-1078-6. Epub 2016 Sep 13.