Safety of bivalirudin in percutaneous coronary intervention following thrombolytic therapy
| Autor: | Gabriel L, Sardi, Joseph, Lindsay, Ron, Waksman |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Time Factors Heparin Coronary Thrombosis Patient Selection Myocardial Infarction Anticoagulants Hemorrhage Hirudins Middle Aged Combined Modality Therapy Antithrombins Peptide Fragments Recombinant Proteins Percutaneous Coronary Intervention Treatment Outcome Recurrence Risk Factors Humans Female Thrombolytic Therapy Hospital Mortality Aged Retrospective Studies |
| Zdroj: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 82(4) |
| ISSN: | 1522-726X |
| Popis: | This study was undertaken to evaluate the safety of bivalirudin (BIV) use during percutaneous coronary intervention (PCI), following thrombolytic therapy in patients with ST-segment elevation myocardial infarction (STEMI).BIV has emerged as a safer anticoagulant than unfractionated heparin (UFH) during primary PCI; however, its use in patients who receive thrombolytic therapy has not been established.A consecutive series of 104 patients who presented with STEMI treated with full-dose thrombolytics and who subsequently received PCI within 6 hr was identified and analyzed. BIV use was compared with UFH for in-hospital bleeding and ischemic events. The primary end points were the rate of major bleeding and the rate of net adverse clinical events as defined in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. The study cohort consisted of 104 patients, of whom 47 (45%) received BIV and 57 (55%) received UFH.Patients on BIV were more frequently preloaded with clopidogrel, while intraprocedural glycoprotein IIb/IIIa inhibitors were used only in UFH patients. In-hospital death, ischemic events, and thrombolysis in myocardial infarction major bleeding occurred more frequently in patients treated with UFH. The net adverse clinical events rate was lower in the intraprocedural BIV group (3 [6.4%] vs. 12 [21.1%] UFH, P = 0.034).The use of BIV in patients presenting with STEMI who were pretreated with thrombolytic therapy and who subsequently underwent PCI is safe and is associated with less ischemic and bleeding events when compared with UFH, and should be considered as the first line anticoagulant for these patients during PCI. |
| Databáze: | OpenAIRE |
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