PMID- 27818120
OWN - NLM
STAT- MEDLINE
DCOM- 20170131
LR  - 20170131
IS  - 1875-2128 (Electronic)
IS  - 1875-2128 (Linking)
VI  - 109
IP  - 12
DP  - 2016 Dec
TI  - Efficacy and safety of prehospital administration of unfractionated heparin, 
      enoxaparin or bivalirudin in patients undergoing primary percutaneous coronary 
      intervention for ST-segment elevation myocardial infarction: Insights from the 
      ORBI registry.
PG  - 696-707
LID - S1875-2136(16)30168-1 [pii]
LID - 10.1016/j.acvd.2015.10.007 [doi]
AB  - BACKGROUND: Despite numerous studies in recent years, the best anticoagulant 
      option for primary percutaneous coronary intervention (PCI) remains a matter of 
      debate. AIMS: To compare in-hospital outcomes after prehospital administration of 
      low-dose unfractionated heparin (UFH)+/-glycoprotein IIb/IIIa inhibitors (GPIs), 
      enoxaparin+/-GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment 
      elevation myocardial infarction (STEMI). METHODS: A total of 1720 patients 
      (median age 62.0 years, 79.2% male) who had been enrolled in a prospective 
      registry and received an injectable anticoagulant in physician-staffed mobile 
      intensive care units before primary PCI were included in the study. The main 
      outcomes were in-hospital major adverse cardiovascular events (MACE) (a composite 
      of all-cause mortality, non-fatal myocardial infarction, stroke or definite stent 
      thrombosis) and in-hospital major bleeding (Bleeding academic research consortium 
      type 3 or 5). RESULTS: UFH was administered in 420 (24.4%) patients, enoxaparin 
      in 1163 (67.6%) patients and bivalirudin in 137 patients (8.0%). Rates of 
      in-hospital MACE were 7.4% with UFH, 6.0% with enoxaparin and 6.6% with 
      bivalirudin, with no significant differences between groups (P=0.628). 
      In-hospital major bleeding occurred in 1.7% of patients on UFH, 1.4% on 
      enoxaparin and 1.5% on bivalirudin (P=0.851). By multivariable analysis, the 
      prehospital anticoagulant used was not an independent predictor of MACE or major 
      bleeding. CONCLUSION: In this prospective registry, there were no significant 
      differences in the rates of in-hospital MACE or major bleeding after prehospital 
      initiation of UFH, enoxaparin or bivalirudin in patients treated by primary PCI 
      for STEMI.
CI  - Copyright (c) 2016 Elsevier Masson SAS. All rights reserved.
FAU - Auffret, Vincent
AU  - Auffret V
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France. Electronic address: 
      vincent.auffret@chu-rennes.fr.
FAU - Leurent, Guillaume
AU  - Leurent G
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France.
FAU - Boulmier, Dominique
AU  - Boulmier D
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France.
FAU - Bedossa, Marc
AU  - Bedossa M
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France.
FAU - Zabalawi, Amer
AU  - Zabalawi A
AD  - Service de cardiologie, centre hospitalier de Saint-Brieuc, Saint-Brieuc, France.
FAU - Hacot, Jean-Philippe
AU  - Hacot JP
AD  - Service de cardiologie, centre hospitalier de Lorient, Lorient, France.
FAU - Coudert, Isabelle
AU  - Coudert I
AD  - SAMU, centre hospitalier de Saint-Brieuc, Saint-Brieuc, France.
FAU - Filippi, Emmanuelle
AU  - Filippi E
AD  - Service de cardiologie, centre hospitalier de Vannes, Vannes, France.
FAU - Castellant, Philippe
AU  - Castellant P
AD  - Departement de cardiologie, CHU de Brest, Brest, France; EA4324, UFR sciences et 
      techniques, optimisation des regulations physiologiques (ORPhy), Brest, France.
FAU - Rialan, Antoine
AU  - Rialan A
AD  - Service de cardiologie, centre hospitalier de Saint-Malo, Saint-Malo, France.
FAU - Rouault, Gilles
AU  - Rouault G
AD  - Service de cardiologie, centre hospitalier de Quimper, Quimper, France.
FAU - Druelles, Philippe
AU  - Druelles P
AD  - Service de cardiologie, clinique Saint-Laurent, Rennes, France.
FAU - Boulanger, Bertrand
AU  - Boulanger B
AD  - SAMU, centre hospitalier de Vannes, Vannes, France.
FAU - Treuil, Josiane
AU  - Treuil J
AD  - SAMU, CHU de Brest, Brest, France.
FAU - Avez, Bertrand
AU  - Avez B
AD  - Service des urgences medicales, CHU de Rennes, Rennes, France.
FAU - Le Guellec, Marielle
AU  - Le Guellec M
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France.
FAU - Gilard, Martine
AU  - Gilard M
AD  - Departement de cardiologie, CHU de Brest, Brest, France; EA4324, UFR sciences et 
      techniques, optimisation des regulations physiologiques (ORPhy), Brest, France.
FAU - Le Breton, Herve
AU  - Le Breton H
AD  - Service de cardiologie et maladies vasculaires, CHU de Rennes, 2, rue 
      Henri-Le-Guilloux, 35000 Rennes, France; Universite de Rennes 1, LTSI, Rennes, 
      France; Inserm, U1099, Rennes, France.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20161103
PL  - Netherlands
TA  - Arch Cardiovasc Dis
JT  - Archives of cardiovascular diseases
JID - 101465655
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Enoxaparin)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/administration & dosage
MH  - Antithrombins/administration & dosage
MH  - Electrocardiography
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin/*administration & dosage
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*administration & dosage
MH  - *Percutaneous Coronary Intervention
MH  - Preoperative Care/*methods
MH  - Prospective Studies
MH  - Recombinant Proteins/administration & dosage
MH  - *Registries
MH  - ST Elevation Myocardial Infarction/diagnosis/physiopathology/*therapy
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Bivalirudin
OT  - Bivalirudine
OT  - Enoxaparin
OT  - Enoxaparine
OT  - Heparine non fractionnee
OT  - Outcomes
OT  - Pronostic
OT  - ST-segment elevation myocardial infarction
OT  - Syndrome coronaire aigu avec elevation du segment ST
OT  - Unfractionated heparin
EDAT- 2016/11/08 06:00
MHDA- 2017/02/01 06:00
CRDT- 2016/11/08 06:00
PHST- 2015/08/21 00:00 [received]
PHST- 2015/09/25 00:00 [revised]
PHST- 2015/10/13 00:00 [accepted]
PHST- 2016/11/08 06:00 [pubmed]
PHST- 2017/02/01 06:00 [medline]
PHST- 2016/11/08 06:00 [entrez]
AID - S1875-2136(16)30168-1 [pii]
AID - 10.1016/j.acvd.2015.10.007 [doi]
PST - ppublish
SO  - Arch Cardiovasc Dis. 2016 Dec;109(12):696-707. doi: 10.1016/j.acvd.2015.10.007. 
      Epub 2016 Nov 3.