PMID- 28303632
OWN - NLM
STAT- MEDLINE
DCOM- 20180626
LR  - 20191114
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Print)
IS  - 1522-1946 (Linking)
VI  - 90
IP  - 5
DP  - 2017 Nov 1
TI  - The comparative safety and effectiveness of bivalirudin versus heparin 
      monotherapy in patients on dialysis undergoing percutaneous coronary 
      intervention: Insights from the Blue Cross Blue Shield of Michigan cardiovascular 
      consortium.
PG  - 724-732
LID - 10.1002/ccd.27001 [doi]
AB  - BACKGROUND: Dialysis patients are at a higher risk of bleeding after percutaneous 
      coronary intervention (PCI); however, due to their exclusion from randomized 
      clinical trials, the optimal antithrombotic regimen for this population remains 
      unknown. We sought to evaluate the comparative safety and effectiveness of 
      bivalirudin monotherapy versus unfractionated heparin (UFH) monotherapy in 
      dialysis patients undergoing PCI. METHODS: We included dialysis patients who 
      underwent PCI in a multicenter registry between January 2010 and September 2015 
      at 47 Michigan hospitals. We compared in-hospital outcomes between bivalirudin 
      versus UFH; excluding those treated with glycoprotein IIb/IIIa inhibitors. 
      Optimal full matching was used to account for the nonrandom use of these drugs. 
      RESULTS: Of 177,963 patients who underwent PCI, 4,303 (2.4%) were on dialysis. 
      Among those, 1,257 (29.2%) received bivalirudin monotherapy and 2,112 (49.1%) 
      received UFH monotherapy. Patients treated with bivalirudin had fewer 
      comorbidities. After matching, there were no significant differences in outcomes 
      between those who received bivalirudin versus UFH: bleeding (adjusted odds ratio: 
      0.67; 95% confidence interval: 0.41-1.07; P = 0.093); major bleeding (0.81; 
      0.19-3.50; P = 0.77); transfusion (1.01; 0.77-1.33; P = 0.96); repeat PCI (0.57; 
      0.14-2.24; P = 0.42); stent thrombosis (0.56; 0.05-5.83; P = 0.63); and death 
      (0.84; 0.46-1.51; P = 0.55). CONCLUSIONS: We found no significant differences in 
      in-hospital outcomes between bivalirudin and UFH monotherapy among dialysis 
      patients undergoing PCI. Randomized clinical trials are needed to determine the 
      optimal anticoagulant regimen for this population. (c) 2017 Wiley Periodicals, Inc.
CI  - (c) 2017 Wiley Periodicals, Inc.
FAU - Sukul, Devraj
AU  - Sukul D
AD  - Department of Internal Medicine, Division of Cardiovascular Medicine, University 
      of Michigan, Ann Arbor, Michigan.
FAU - Seth, Milan
AU  - Seth M
AD  - Department of Internal Medicine, Division of Cardiovascular Medicine, University 
      of Michigan, Ann Arbor, Michigan.
FAU - Schreiber, Theodore
AU  - Schreiber T
AD  - Detroit Medical Center-Cardiovascular Institute, Detroit, Michigan.
FAU - Khandelwal, Akshay
AU  - Khandelwal A
AD  - Division of Cardiology, Henry Ford Health System, Detroit, Michigan.
FAU - Cannon, Louis A
AU  - Cannon LA
AD  - McLaren-Northern Michigan Regional Hospital, Petoskey, Michigan.
FAU - LaLonde, Thomas A
AU  - LaLonde TA
AD  - Department of Cardiovascular Medicine, St. John Hospital and Medical Center, 
      Detroit, Michigan.
FAU - Gurm, Hitinder S
AU  - Gurm HS
AUID- ORCID: 0000-0002-1646-0218
AD  - Department of Internal Medicine, Division of Cardiovascular Medicine, University 
      of Michigan, Ann Arbor, Michigan.
AD  - Cardiovascular Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
LA  - eng
GR  - T32 HL007853/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20170317
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. 2017 Nov 1;90(5):733-734. PMID: 29105331
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antithrombins/adverse effects/*therapeutic use
MH  - *Blue Cross Blue Shield Insurance Plans
MH  - Comparative Effectiveness Research
MH  - Coronary Artery Disease/complications/diagnostic imaging/*therapy
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Michigan
MH  - Middle Aged
MH  - Odds Ratio
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - *Percutaneous Coronary Intervention/adverse effects/instrumentation
MH  - Propensity Score
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Registries
MH  - *Renal Dialysis/adverse effects
MH  - Renal Insufficiency, Chronic/complications/diagnosis/physiopathology/*therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stents
MH  - Thrombosis/diagnosis/etiology/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6850212
MID - NIHMS1053101
OTO - NOTNLM
OT  - anticoagulant
OT  - chronic kidney disease
OT  - dialysis
OT  - outcomes
OT  - percutaneous coronary intervention
COIS- Disclosures: Hitinder S. Gurm receives research funding from Blue Cross Blue 
      Shield of Michigan, the National Institutes of Health and is a consultant for 
      Osprey Medical. None of the authors have any conflicts directly relevant to this 
      study.
EDAT- 2017/03/18 06:00
MHDA- 2018/06/27 06:00
PMCR- 2019/11/12
CRDT- 2017/03/18 06:00
PHST- 2017/01/27 00:00 [received]
PHST- 2017/02/04 00:00 [accepted]
PHST- 2017/03/18 06:00 [pubmed]
PHST- 2018/06/27 06:00 [medline]
PHST- 2017/03/18 06:00 [entrez]
PHST- 2019/11/12 00:00 [pmc-release]
AID - 10.1002/ccd.27001 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2017 Nov 1;90(5):724-732. doi: 10.1002/ccd.27001. 
      Epub 2017 Mar 17.