PMID- 30359789
OWN - NLM
STAT- MEDLINE
DCOM- 20190114
LR  - 20190114
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 172
DP  - 2018 Dec
TI  - Comparison of the antiplatelet and antithrombotic effects of bivalirudin versus 
      unfractionated heparin: A platelet substudy of the HEAT PPCI trial.
PG  - 36-43
LID - S0049-3848(18)30553-X [pii]
LID - 10.1016/j.thromres.2018.09.062 [doi]
AB  - In randomised trials, bivalirudin has been associated with higher rates of acute 
      stent thrombosis (AST) compared to unfractionated heparin (UFH), without 
      mechanistic explanation. Furthermore, data are discrepant regards the 
      antiplatelet effects of bivalirudin. This prespecified study, part of a larger 
      HEAT-PPCI Platelet Substudy, aimed to compare the antiplatelet and antithrombotic 
      effects of bivalirudin and UFH using short thrombelastography (s-TEG), an ex vivo 
      whole blood platelet function assay. In HEAT-PPCI, patients were randomised to 
      receive UFH or bivalirudin before angiography. Assay with s-TEG was performed in 
      184 patients (10.2%) at end of procedure (EOP) and repeated at 24 h. In addition 
      to adenosine diphosphate- (ADP) and arachidonic acid- (AA) mediated platelet 
      aggregation, thrombin-mediated clotting (TMC) was assessed using kaolin with and 
      without heparinase. There were no significant differences between UFH and 
      bivalirudin in ADP- and AA-mediated platelet aggregation at EOP or 24 h. Whilst 
      UFH obliterated TMC at EOP, bivalirudin prolonged R time (19.7 min [15.9-25.4] 
      vs. 8.4 min [7.5-10]; P < 0.0001), K time (2.4 min [1.9-3.4] vs. 2.2 min 
      [1.8-2.7]; P = 0.007) and significantly increased maximum clot strength (MA 
      62.7 mm [58.7-67.4] vs. 58.6 [55-63]; P = 0.0005), compared to control. In 
      conclusion, there were no significant differences in the antiplatelet effects of 
      UFH and bivalirudin. However, whilst UFH obliterated TMC, bivalirudin prolonged 
      clot initiation but potentiated maximum clot strength. As AST is likely 
      multifactorial in aetiology, in patients treated with bivalirudin, increased clot 
      strength may contribute to this hazard in some individuals and this observation 
      warrants further investigation.
CI  - Copyright (c) 2018. Published by Elsevier Ltd.
FAU - Khanna, Vikram
AU  - Khanna V
AD  - University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of 
      Medicine, University of Southampton, Southampton, UK. Electronic address: 
      vikram.khanna@nuth.nhs.uk.
FAU - Shahzad, Adeel
AU  - Shahzad A
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Thayalasamy, Kala
AU  - Thayalasamy K
AD  - Faculty of Medicine, University of Southampton, Southampton, UK.
FAU - Kemp, Ian
AU  - Kemp I
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Mars, Christine
AU  - Mars C
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Cooper, Rob
AU  - Cooper R
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Roome, Claire
AU  - Roome C
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Wilson, Keith
AU  - Wilson K
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Harris, Scott
AU  - Harris S
AD  - Faculty of Medicine, University of Southampton, Southampton, UK.
FAU - Stables, Rod
AU  - Stables R
AD  - Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest 
      Hospital NHS Trust, Liverpool, UK.
FAU - Curzen, Nick
AU  - Curzen N
AD  - University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of 
      Medicine, University of Southampton, Southampton, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20180928
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Antithrombins/*pharmacology/therapeutic use
MH  - Blood Platelets/cytology/*drug effects
MH  - Female
MH  - Heparin/*pharmacology/therapeutic use
MH  - Hirudins/*pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/*pharmacology/therapeutic use
MH  - Platelet Aggregation/drug effects
MH  - Platelet Aggregation Inhibitors/*pharmacology/therapeutic use
MH  - Recombinant Proteins/pharmacology/therapeutic use
MH  - Thrombelastography
OTO - NOTNLM
OT  - Bivalirudin
OT  - Heparin
OT  - Platelet function
OT  - Stent thrombosis
OT  - Thrombelastography
OT  - Thrombin
EDAT- 2018/10/26 06:00
MHDA- 2019/01/15 06:00
CRDT- 2018/10/26 06:00
PHST- 2018/02/26 00:00 [received]
PHST- 2018/08/16 00:00 [revised]
PHST- 2018/09/27 00:00 [accepted]
PHST- 2018/10/26 06:00 [pubmed]
PHST- 2019/01/15 06:00 [medline]
PHST- 2018/10/26 06:00 [entrez]
AID - S0049-3848(18)30553-X [pii]
AID - 10.1016/j.thromres.2018.09.062 [doi]
PST - ppublish
SO  - Thromb Res. 2018 Dec;172:36-43. doi: 10.1016/j.thromres.2018.09.062. Epub 2018 
      Sep 28.