PMID- 28377232
OWN - NLM
STAT- MEDLINE
DCOM- 20180503
LR  - 20180503
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 26
IP  - 12
DP  - 2017 Dec
TI  - Comparison of Safety and Efficacy of Unfractionated Heparin Versus Bivalirudin in 
      Patients Undergoing Percutaneous Coronary Intervention.
PG  - 1277-1281
LID - S1443-9506(17)30077-X [pii]
LID - 10.1016/j.hlc.2016.12.019 [doi]
AB  - BACKGROUND: Anti-platelet and anti-coagulant adjunctive therapies are associated 
      with a clinically significant increased risk of major bleeding. We 
      retrospectively assessed in-hospital major adverse clinical events (MACE) and 
      major bleeding in patients undergoing percutaneous coronary intervention (PCI) 
      who received either unfractionated heparin (UFH) or bivalirudin. METHOD: 
      Consecutive patients undergoing PCI for acute coronary syndrome (ACS) at 
      Fremantle Hospital from August 2008 to December 2013 were identified. Patients 
      received dual antiplatelet therapy (DAPT), with either UFH (50-100IU/kg) or 
      bivalirudin (bolus 0.75mg/kg and infusion 1.75mg/kg/hr). Adjunctive glycoprotein 
      IIb/IIIa (GPIIbIIIa) antagonist use was at the operator's discretion. In-hospital 
      events were identified from case notes and PCI database review. RESULTS: Of 3371 
      patients identified, 1740 received UFH and 1631 received bivalirudin. The two 
      groups were similar with respect to age, 62.5 SD 12.1 yrs vs. 62.8 SD 12.2 yrs, 
      (p=0.575) female gender, 24% vs. 26% (p=0.10), current smokers, 66% vs. 70% 
      (p=0.53), diabetes, 25% vs. 26% (p=0.62) and the use of DAPT (p=ns). Presentation 
      with ST-segment-elevation myocardial infarction (STEMI) was significantly higher 
      in the UFH group (28% vs. 19%, p<0.001). The use of transfemoral arterial access 
      was similar (93% UFH vs. 92% bivalirudin) (p=0.41). More patients received 
      GPIIb/IIIa antagonist in the UFH group (30% vs. 3%; p <0.001). There was no 
      difference in pre-discharge acute stent thrombosis (<24hours) occurring in 1.0% 
      with UFH vs. 0.5% with bivalirudin (p=0.20). The equipoise on the outcomes of 
      stent thrombosis persisted after multivariate adjustment for difference in rates 
      of STEMI. In-hospital BARC Type 1-3 major bleeding occurred in 3.7% in the UFH 
      group vs. 2.9% in the bivalirudin group (p=0.20). CONCLUSION: Unfractionated 
      heparin compared with bivalirudin was not associated with a higher incidence of 
      in-hospital MACE or major bleeding in a cohort with overall high rates of 
      transfemoral access, despite significantly higher use of GPIIb/IIIa antagonists 
      in the UFH group.
CI  - Copyright (c) 2017 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      Published by Elsevier B.V. All rights reserved.
FAU - Rehmani, Ahmed
AU  - Rehmani A
AD  - Department of Cardiology, Fremantle Hospital, Perth, WA, Australia. Electronic 
      address: ahmedukhan@yahoo.com.
FAU - Judkins, Chris
AU  - Judkins C
AD  - Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
FAU - Whelan, Alan
AU  - Whelan A
AD  - Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
FAU - Nguyen, Michael
AU  - Nguyen M
AD  - Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
FAU - Schultz, Carl
AU  - Schultz C
AD  - Department of Cardiology, Fremantle Hospital, Perth, WA, Australia; Department of 
      Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, 
      University of Western Australia, Perth, WA, Australia.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170228
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/surgery
MH  - Aged
MH  - Antithrombins/administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage
MH  - Follow-Up Studies
MH  - Heparin/*administration & dosage
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*administration & dosage
MH  - *Percutaneous Coronary Intervention
MH  - Postoperative Hemorrhage/chemically induced/*epidemiology
MH  - Recombinant Proteins/administration & dosage
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Bare metal stent
OT  - Drug-eluting stent
OT  - Dual anti-platelet therapy
OT  - Major adverse cardiac events
OT  - Percutaneous coronary intervention
OT  - Unfractionated heparin
EDAT- 2017/04/06 06:00
MHDA- 2018/05/04 06:00
CRDT- 2017/04/06 06:00
PHST- 2016/05/04 00:00 [received]
PHST- 2016/12/26 00:00 [accepted]
PHST- 2017/04/06 06:00 [pubmed]
PHST- 2018/05/04 06:00 [medline]
PHST- 2017/04/06 06:00 [entrez]
AID - S1443-9506(17)30077-X [pii]
AID - 10.1016/j.hlc.2016.12.019 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2017 Dec;26(12):1277-1281. doi: 10.1016/j.hlc.2016.12.019. Epub 
      2017 Feb 28.