PMID- 29432119 OWN - NLM STAT- MEDLINE DCOM- 20190729 LR - 20190729 IS - 1941-7632 (Electronic) IS - 1941-7640 (Linking) VI - 11 IP - 2 DP - 2018 Feb TI - Anticoagulant Use Among Patients With End-Stage Renal Disease Undergoing Percutaneous Coronary Intervention: An Analysis From the National Cardiovascular Data Registry. PG - e005628 LID - 10.1161/CIRCINTERVENTIONS.117.005628 [doi] AB - BACKGROUND: Patients with end-stage renal disease undergoing percutaneous coronary intervention (PCI) have largely been excluded from trials of antithrombotic therapies leaving little data to guide agent choice in this population. METHODS AND RESULTS: The National Cardiovascular Data Registry CathPCI Registry was used to identify patients with end-stage renal disease undergoing PCI who received monotherapy with either bivalirudin or unfractionated heparin (UFH) (n=71 675). In hospital bleeding and mortality were compared and adjusted using the CathPCI Registry logistic regression models with generalized estimating equations with UFH as the reference. Bivalirudin was used in 51.3% of patients versus 48.7% for UFH. The use of bivalirudin decreased over time, and in 2014, UFH became the most frequently used. Patients receiving UFH were more likely to have an acute coronary syndrome presentation (37.8% versus 27.4%) or have cardiogenic shock (3.74% versus 1.98%). The observed rates for in hospital bleeding (7.0% versus 9.5%; adjusted odds ratio,0.82; 95% confidence interval, 0.76-0.87) and mortality (2.6% versus 4.2%; adjusted odds ratio, 0.87; 95% confidence interval, 0.78-0.97) were lower for patients receiving bivalirudin compared with those receiving UFH. CONCLUSIONS: In patients with end-stage renal disease undergoing PCI, bivalirudin and UFH were used with similar frequency although the patterns of use changed over the enrollment period. Patients with end-stage renal disease undergoing PCI had a lower adjusted risk of in hospital outcomes with bivalirudin; however, given the observational nature of this analysis, a randomized trial is warranted. CI - (c) 2018 American Heart Association, Inc. FAU - Washam, Jeffrey B AU - Washam JB AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.) jeff.washam@duke.edu. FAU - Kaltenbach, Lisa A AU - Kaltenbach LA AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). FAU - Wojdyla, Daniel M AU - Wojdyla DM AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). FAU - Patel, Manesh R AU - Patel MR AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). FAU - Klein, Andrew J AU - Klein AJ AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). FAU - Abbott, J Dawn AU - Abbott JD AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). FAU - Rao, Sunil V AU - Rao SV AD - From the Duke University Medical Center, Durham, NC (J.B.W., M.R.P., S.V.R.); Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W., M.R.P., S.V.R.); Piedmont Heart Institute, Atlanta, GA (A.J.K.); and Brown Medical School, Providence, RI (J.D.A.). LA - eng PT - Comparative Study PT - Journal Article PT - Observational Study PL - United States TA - Circ Cardiovasc Interv JT - Circulation. Cardiovascular interventions JID - 101499602 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) MH - Aged MH - Anticoagulants/*administration & dosage/adverse effects MH - Antithrombins/*administration & dosage/adverse effects MH - Coronary Artery Disease/complications/diagnostic imaging/mortality/*surgery MH - Female MH - Hemorrhage/chemically induced/mortality MH - Heparin/*administration & dosage/adverse effects MH - Hirudins/*administration & dosage/adverse effects MH - Hospital Mortality MH - Humans MH - Kidney/physiopathology MH - Kidney Failure, Chronic/*complications/diagnosis/mortality/physiopathology MH - Male MH - Middle Aged MH - Peptide Fragments/*administration & dosage/adverse effects MH - *Percutaneous Coronary Intervention/adverse effects/mortality MH - Practice Patterns, Physicians' MH - Recombinant Proteins/administration & dosage/adverse effects MH - Registries MH - Risk Factors MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - acute coronary syndrome OT - bivalirudin OT - heparin OT - kidney failure, chronic OT - percutaneous coronary intervention EDAT- 2018/02/13 06:00 MHDA- 2019/07/30 06:00 CRDT- 2018/02/13 06:00 PHST- 2017/06/12 00:00 [received] PHST- 2018/01/05 00:00 [accepted] PHST- 2018/02/13 06:00 [entrez] PHST- 2018/02/13 06:00 [pubmed] PHST- 2019/07/30 06:00 [medline] AID - CIRCINTERVENTIONS.117.005628 [pii] AID - 10.1161/CIRCINTERVENTIONS.117.005628 [doi] PST - ppublish SO - Circ Cardiovasc Interv. 2018 Feb;11(2):e005628. doi: 10.1161/CIRCINTERVENTIONS.117.005628.