Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes
| Autor: | Valgimigli, Marco, Frigoli, Enrico, Leonardi, Sergio, Rothenbühler, Martina, Gagnor, Andrea, Calabrò, Paolo, Garducci, Stefano, Rubartelli, Paolo, Briguori, Carlo, Andò, Giuseppe, Repetto, Alessandra, Limbruno, Ugo, Garbo, Roberto, Sganzerla, Paolo, Russo, Filippo, Lupi, Alessandro, Cortese, Bernardo, Ausiello, Arturo, Ierna, Salvatore, Esposito, Giovanni, Presbitero, Patrizia, Santarelli, Andrea, Sardella, Gennaro, Varbella, Ferdinando, Tresoldi, Simone, De Cesare, Nicoletta, Rigattieri, Stefano, Zingarelli, Antonio, Tosi, Paolo, Van't Hof, Arnoud, Boccuzzi, Giacomo, Omerovic, Elmir, Sabaté, Manel, Heg, Dik, Jüni, Peter, Vranckx, Pascal, Petronio, Anna |
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| Přispěvatelé: | Valgimigli, Marco, Frigoli, Enrico, Leonardi, Sergio, Rothenbühler, Martina, Gagnor, Andrea, Calabrò, Paolo, Garducci, Stefano, Rubartelli, Paolo, Briguori, Carlo, Andò, Giuseppe, Repetto, Alessandra, Limbruno, Ugo, Garbo, Roberto, Sganzerla, Paolo, Russo, Filippo, Lupi, Alessandro, Cortese, Bernardo, Ausiello, Arturo, Ierna, Salvatore, Esposito, Giovanni, Presbitero, Patrizia, Santarelli, Andrea, Sardella, Gennaro, Varbella, Ferdinando, Tresoldi, Simone, de Cesare, Nicoletta, Rigattieri, Stefano, Zingarelli, Antonio, Tosi, Paolo, van 't Hof, Arnoud, Boccuzzi, Giacomo, Omerovic, Elmir, Sabaté, Manel, Heg, Dik, Jüni, Peter, Vranckx, Pascal, Cardiology, Calabro', Paolo |
| Rok vydání: | 2015 |
| Předmět: |
Hirudin
Male medicine.medical_treatment Myocardial Infarction recombinant proteins Peptide Fragment Coronary thrombosis hirudins Stent Bivalirudin Infusions Intravenou Myocardial infarction humans Incidence acute coronary syndrome aged anticoagulants combined modality therapy coronary thrombosis female heparin incidence infusions intravenous male middle aged myocardial infarction peptide fragments percutaneous coronary intervention stents stroke medicine (all) General Medicine Heparin Middle Aged Recombinant Protein Combined Modality Therapy Stroke surgical procedures operative Cardiology Female Human medicine.drug Acute coronary syndrome medicine.medical_specialty Coronary Thrombosi 610 Medicine & health Revascularization Percutaneous Coronary Intervention 360 Social problems & social services Internal medicine medicine cardiovascular diseases Acute Coronary Syndrome Aged business.industry Anticoagulant Percutaneous coronary intervention medicine.disease infusions intravenous Conventional PCI business |
| Zdroj: | New England Journal of Medicine, 373(11), 997-1009. Massachussetts Medical Society Valgimigli, Marco; Frigoli, Enrico; Leonardi, Sergio; Rothenbühler, Martina; Gagnor, Andrea; Calabrò, Paolo; Garducci, Stefano; Rubartelli, Paolo; Briguori, Carlo; Andò, Giuseppe; Repetto, Alessandra; Limbruno, Ugo; Garbo, Roberto; Sganzerla, Paolo; Russo, Filippo; Lupi, Alessandro; Cortese, Bernardo; Ausiello, Arturo; Ierna, Salvatore; Esposito, Giovanni; ... (2015). Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes. New England journal of medicine NEJM, 373(11), pp. 997-1009. Massachusetts Medical Society MMS 10.1056/NEJMoa1507854 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa1507854 |
| Popis: | BACKGROUND Conflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome. METHODS We randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin. Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion. Primary outcomes for the comparison between bivalirudin and heparin were the occurrence of major adverse cardiovascular events (a composite of death, myocardial infarction, or stroke) and net adverse clinical events (a composite of major bleeding or a major adverse cardiovascular event). The primary outcome for the comparison of a post-PCI bivalirudin infusion with no post-PCI infusion was a composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events. RESULTS The rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (10.3% and 10.9%, respectively; relative risk, 0.94; 95% confidence interval [CI], 0.81 to 1.09; P = 0.44), nor was the rate of net adverse clinical events (11.2% and 12.4%, respectively; relative risk, 0.89; 95% CI, 0.78 to 1.03; P = 0.12). Post-PCI bivalirudin infusion, as compared with no infusion, did not significantly decrease the rate of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (11.0% and 11.9%, respectively; relative risk, 0.91; 95% CI, 0.74 to 1.11; P = 0.34). CONCLUSIONS In patients with an acute coronary syndrome, the rates of major adverse cardiovascular events and net adverse clinical events were not significantly lower with bivalirudin than with unfractionated heparin. The rate of the composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events was not significantly lower with a post-PCI bivalirudin infusion than with no post-PCI infusion. (Funded by the Medicines Company and Terumo Medical; MATRIX ClinicalTrials.gov number, NCT01433627.) abstr act |
| Databáze: | OpenAIRE |
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