TY - JOUR
T1 - Bivalirudin With Provisional Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Primary Angioplasty in the Setting of Cardiogenic Shock
AU - Bonello, Laurent
AU - De Labriolle, Axel
AU - Roy, Probal
AU - Steinberg, Daniel H.
AU - Pinto Slottow, Tina L.
AU - Xue, Zhenyi
AU - Smith, Kimberley
AU - Torguson, Rebecca
AU - Suddath, William O.
AU - Satler, Lowell F.
AU - Kent, Kenneth M.
AU - Pichard, Augusto D.
AU - Waksman, Ron
PY - 2008/8/1
Y1 - 2008/8/1
N2 - In patients undergoing percutaneous coronary intervention (PCI), clinical trials have demonstrated that the use of bivalirudin with provisional glycoprotein IIb/IIIa inhibitors is not inferior to heparin with systematic glycoprotein IIb/IIIa inhibitors on major adverse cardiac events and is associated with lower rates of bleeding in various clinical settings. Patients with cardiogenic shock (CS), however, have been excluded from all pivotal trials. A retrospective analysis of 86 consecutive patients undergoing PCI for acute myocardial infarction complicated by CS in our center from April 2003 to September 2007 was performed. In-hospital death, major adverse cardiac events, and bleeding rates were compared in 37 patients who received bivalirudin with or without glycoprotein IIb/IIIa inhibitors and 49 patients who were treated with heparin and glycoprotein IIb/IIIa inhibitors as anticoagulation management. Baseline demographic, clinical, and biological characteristics were similar in the 2 groups. The in-hospital death rate was significantly lower in the bivalirudin group (5.4 vs 32.7%, p = 0.002). There were no differences in the rate of major hematoma between the bivalirudin group and the heparin group (3 vs 2.6%, p = 0.46). In conclusion, bivalirudin with provisional use of glycoprotein IIb/IIIa inhibitors appears to be a safe and effective anticoagualtion strategy in patients undergoing primary PCI for acute myocardial infarction complicated by CS.
AB - In patients undergoing percutaneous coronary intervention (PCI), clinical trials have demonstrated that the use of bivalirudin with provisional glycoprotein IIb/IIIa inhibitors is not inferior to heparin with systematic glycoprotein IIb/IIIa inhibitors on major adverse cardiac events and is associated with lower rates of bleeding in various clinical settings. Patients with cardiogenic shock (CS), however, have been excluded from all pivotal trials. A retrospective analysis of 86 consecutive patients undergoing PCI for acute myocardial infarction complicated by CS in our center from April 2003 to September 2007 was performed. In-hospital death, major adverse cardiac events, and bleeding rates were compared in 37 patients who received bivalirudin with or without glycoprotein IIb/IIIa inhibitors and 49 patients who were treated with heparin and glycoprotein IIb/IIIa inhibitors as anticoagulation management. Baseline demographic, clinical, and biological characteristics were similar in the 2 groups. The in-hospital death rate was significantly lower in the bivalirudin group (5.4 vs 32.7%, p = 0.002). There were no differences in the rate of major hematoma between the bivalirudin group and the heparin group (3 vs 2.6%, p = 0.46). In conclusion, bivalirudin with provisional use of glycoprotein IIb/IIIa inhibitors appears to be a safe and effective anticoagualtion strategy in patients undergoing primary PCI for acute myocardial infarction complicated by CS.
UR - http://www.scopus.com/inward/record.url?scp=51749103330&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2008.03.052
DO - 10.1016/j.amjcard.2008.03.052
M3 - Article
C2 - 18638588
AN - SCOPUS:51749103330
SN - 0002-9149
VL - 102
SP - 287
EP - 291
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 3
ER -