Comparison of Bivalirudin Versus Heparin(s) During Percutaneous Coronary Interventions in Patients Receiving Prasugrel: A Propensity‐Matched Study

Abstract BackgroundSeveral percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)‐based regimens ± glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third‐generation oral thienopyridine, has not been previously evaluated. MethodsUsing the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n = 3377) or HEP ± GPI (n = 3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital‐level characteristics, propensity score‐matching (PSM) analyses were performed. ResultsMortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP ± GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95% confidence interval: 0.34‐0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP ± GPI (0.9 ± 2.0 vs 1.2 ± 2.3 days, ...
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: Clinical Investigation Source Type: research

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ConclusionsOur findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favor radial access in patients with a high, but not those with a low, risk of bleeding. Since this was not a primary analysis, it should be considered hypothesis-generating.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
In conclusion, the effects of 1-month DAPT for the primary and major secondary endpoints were consistent in HBR and non-HBR patients without any significant interactions. The benefit of 1-month DAPT in reducing major bleeding was numerically greater in HBR patients.Clinical trial registration Short and optimal duration of dual antiplatelet therapy after everolimus-eluting cobalt –chromium stent-2 [STOPDAPT-2]; NCT02619760.
Source: Cardiovascular Intervention and Therapeutics - Category: Cardiology Source Type: research
THURSDAY, Feb. 20, 2020 -- Polymer-based zotarolimus-eluting stents are noninferior to polymer-free drug-coated stents among patients at high bleeding risk undergoing percutaneous coronary intervention (PCI), according to a study published online...
Source: Drugs.com - Pharma News - Category: Pharmaceuticals Source Type: news
CONCLUSIONS: Patients at HBR defined by the ARC-HBR criteria had a higher risk of BARC 3 or 5 bleeding as well as DOCE. The bleeding risk was related to its individual components. The ARC-HBR criteria was more sensitive to identify patients with future bleedings than other contemporary risk scores at the cost of specificity. PMID: 32065586 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
Abstract Platelet activation and aggregation have a pivotal role in arterial thrombosis and in the pathogenesis of both acute coronary syndromes (ACS) and in the thrombotic complications that occur in patients undergoing percutaneous coronary intervention (PCI). The past 30 years has seen the progress from early trials of clopidogrel and glycoprotein IIb/IIIa inhibitors to the application of more potent P2Y12 inhibitors prasugrel and ticagrelor. Early enthusiasm for newer and more potent antiplatelet agents, which could reduce ischemic events, has led to the understanding of the importance of bleeding and a desire...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
Abstract BACKGROUND: The management of antithrombotic therapy in patients undergoing percutaneous coronary intervention (PCI) with an indication for long-term oral anticoagulant therapy (OAT) is still a matter of debate. We aim to evaluate the safety and the efficacy of dual therapy (DT) compared to triple therapy (TT) in this clinical setting. METHODS: A study level meta-analysis and a review of randomized trials selected using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and abstract from major cardiology congresses. Six randomized trials with 12,156 patients evaluating th...
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
AbstractCoronary artery disease remains the major cause of mortality worldwide. Antiplatelet drugs such as acetylsalicylic acid and P2Y12 receptor antagonists are cornerstone treatments for the prevention of thrombotic events in patients with coronary artery disease. Clopidogrel has long been the gold standard but has major pharmacological limitations such as a slow onset and long duration of effect, as well as weak platelet inhibition with high inter-individual pharmacokinetic and pharmacodynamic variability. There has been a strong need to develop potent P2Y12 receptor antagonists with more favorable pharmacological prop...
Source: Clinical Pharmacokinetics - Category: Drugs & Pharmacology Source Type: research
Background: This meta-analysis is to evaluate the efficacy and safety of bivalirudin in patients with ST-elevation myocardial infarction (STEMI). Methods: PubMed, Cochrane Library, Embase, CNKI, CBMdisc, and VIP database were searched. Randomized controlled trial (RCT) was selected and the meta-analysis was conducted by RevMan 5.1. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) and the primary safety endpoint was the incidence of major bleeding. Secondary efficacy endpoints were myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stoc...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Publication date: April 2020Source: American Heart Journal, Volume 222Author(s): Tim Kinnaird, Sean Gallagher, James C. Spratt, Peter Ludman, Mark de Belder, Samuel Copt, Richard Anderson, Simon Walsh, Colm Hanratty, Nick Curzen, Adrian Banning, Mamas MamasBackgroundComplex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.ObjectiveTo define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.Methods and ResultsData were analyzed on all CHIP-PCI procedures undertaken for sta...
Source: American Heart Journal - Category: Cardiology Source Type: research
Conclusions: Compared to the non-HBR population, HBR patients experienced worse 4-year outcomes after PCI with CoCr everolimus-eluting stent. Both CTE and MB had a significant impact on subsequent risk of mortality irrespective of bleeding risk. PMID: 31992063 [PubMed - as supplied by publisher]
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
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