Would you ask for bivalirudin in the ambulance on the way to the catheter lab for PCI?

 IfI had a heart attack I would have only the faintest idea what my options really were and what their relative harms and merits might be. Perhaps as I was sucking on my aspirin tablet, I might ask the paramedic to leave the blood pressure cuff inflated for about five minutes to achieve a bit of ischaemic preconditioning. I might call for a tot of cardioprotective brandy: they say it goes well with diamorphine. Has anyone done a trial of oral alcohol for acute MI? I suppose I would let the ambulance take me to the nearest catheter lab for PCI, although more than an hour might elapse before I even reached the hospital door. What should I accept on the way there? The Medicines Company hope that I would say bivalirudin. In the EUROMAX trial that they funded, 2218 people with AMI were randomised to either receive bivalirudin on the way to a PCI centre, or else a “optional receipt of a glycoprotein IIb/IIIa inhibitor.” A rather odd study design, made even odder by a change in the composite primary end-point after the trial had started. So compared with optional receipt of a glycoprotein IIb/IIIa inhibitor, and using thepost-commencement composite end-point of death or major bleeding not associated with coronary-artery bypass grafting (CABG), “Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis.” Is that clear t...
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums

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Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 6. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
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