PMID- 29850404
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220317
IS  - 2223-3652 (Print)
IS  - 2223-3660 (Electronic)
IS  - 2223-3652 (Linking)
VI  - 8
IP  - 2
DP  - 2018 Apr
TI  - In-hospital outcomes after switching from a bivalirudin-first strategy to an 
      unfractionated heparin-first strategy for percutaneous coronary interventions.
PG  - 137-145
LID - 10.21037/cdt.2017.10.16 [doi]
AB  - BACKGROUND: The optimal anticoagulation strategy for percutaneous coronary 
      interventions (PCIs) remains debated. We report outcomes after switching from a 
      bivalirudin-first to an unfractionated heparin (UFH)-first strategy for PCIs in a 
      large academic center. METHODS: Patients undergoing PCI from June 1(st) 2013-May 
      31(st), 2015 were identified through the National Cardiovascular Data Registry 
      (NCDR), and divided into the "bivalirudin era" (June 2013-July 2014) and the "UFH 
      era" (October 2014-May 2015). Bleeding outcomes were compared using multivariable 
      logistic regression adjusted for potential confounders. RESULTS: A total of 1,145 
      patients were identified (bivalirudin era =752, UFH era =393). Radial access for 
      PCI increased over time, and was lower in the bivalirudin era (26% vs. 34%, 
      P<0.05). There were 32 major bleeds (4.3%) in the bivalirudin era and 29 major 
      bleeds (7.4%) in the UFH era (P=0.03), with the majority being hemoglobin drops 
      (>/=3 g/dL) without overt clinical bleeding (85.7% of bleeds in the bivalirudin era 
      and 86.2% of bleeds in the UFH era). After adjustments for other common major 
      causes of bleeding, bivalirudin was associated with 78% lower odds of bleeding 
      (OR =0.22; 95% CI: 0.05-0.91). CONCLUSIONS: An increase in major bleeding events 
      occurred after switching to an UFH-first strategy, primarily associated with 
      hemoglobin drop (>/=3 g/dL) without overt clinical bleeding. Major overt bleeding 
      was rare (0.3%) and similar in both groups. These results suggest a UFH-first 
      strategy for PCI may have a role in patients with low bleeding risk.
FAU - Jaswaney, Rahul V
AU  - Jaswaney RV
AD  - School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 
      USA.
FAU - Caughey, Melissa C
AU  - Caughey MC
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - End, Christopher
AU  - End C
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - Sudar, Patricia
AU  - Sudar P
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - Yeung, Michael
AU  - Yeung M
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - Kaul, Prashant
AU  - Kaul P
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
AD  - Piedmont Heart Institute, Atlanta, GA, USA.
FAU - Rossi, Joseph S
AU  - Rossi JS
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - Stouffer, George A
AU  - Stouffer GA
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
FAU - Vavalle, John P
AU  - Vavalle JP
AD  - Division of Cardiology, Department of Medicine, University of North Carolina at 
      Chapel Hill, Chapel Hill, NC, USA.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Cardiovasc Diagn Ther
JT  - Cardiovascular diagnosis and therapy
JID - 101601613
EIN - Cardiovasc Diagn Ther. 2018 Jun;8(3):E1-E2. PMID: 29930897
PMC - PMC5951987
OTO - NOTNLM
OT  - Bivalirudin
OT  - bleeding
OT  - percutaneous coronary intervention (PCI)
OT  - unfractionated heparin (UFH)
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/06/01 06:00
MHDA- 2018/06/01 06:01
PMCR- 2018/04/01
CRDT- 2018/06/01 06:00
PHST- 2018/06/01 06:00 [entrez]
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2018/06/01 06:01 [medline]
PHST- 2018/04/01 00:00 [pmc-release]
AID - cdt-08-02-137 [pii]
AID - 10.21037/cdt.2017.10.16 [doi]
PST - ppublish
SO  - Cardiovasc Diagn Ther. 2018 Apr;8(2):137-145. doi: 10.21037/cdt.2017.10.16.