Bleeding Risk and Outcomes of Bivalirudin Versus Glycoprotein IIb/IIIa Inhibitors With Targeted Low-Dose Unfractionated Heparin in Patients Having Percutaneous Coronary Intervention for Either Stable or Unstable Angina Pectoris

For patients undergoing elective percutaneous coronary intervention (PCI), procedural anticoagulation with bivalirudin was previously shown to significantly reduce bleeding complications at the cost of a modest increase in ischemic events compared with unfractionated heparin (UFH) and glycoprotein I...

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Bibliographic Details
Published in:The American journal of cardiology 2008-07, Vol.102 (2), p.160-164
Main Authors: Steinberg, Daniel H., MD, Shah, Palak, MD, Kinnaird, Tim, MD, Pinto Slottow, Tina L., MD, Roy, Probal K., MD, Okabe, Teruo, MD, Bonello, Laurent, MD, de Labriolle, Axel, MD, Smith, Kimberly A., BS, Torguson, Rebecca, MPH, Xue, Zhenyi, MS, Suddath, William O., MD, Kent, Kenneth M., MD, PhD, Satler, Lowell F., MD, Pichard, Augusto D., MD, Lindsay, Joseph, MD, Waksman, Ron, MD
Format: Article
Language:English
Subjects:
Angina pectoris
Angina Pectoris - drug therapy
Angina, Unstable - drug therapy
Angioplasty
Angioplasty, Balloon, Coronary - adverse effects
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Coronary heart disease
Diseases of the cardiovascular system
Drug dosages
Female
Heart
Hemorrhage
Hemorrhage - chemically induced
Hemorrhage - prevention & control
Heparin - adverse effects
Heparin - therapeutic use
Hirudins - adverse effects
Humans
Male
Medical sciences
Middle Aged
Peptide Fragments - adverse effects
Peptide Fragments - therapeutic use
Pharmacology
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Postoperative Complications
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Recombinant Proteins - adverse effects
Recombinant Proteins - therapeutic use
Risk Assessment
Risk Factors
Treatment Outcome
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Summary:For patients undergoing elective percutaneous coronary intervention (PCI), procedural anticoagulation with bivalirudin was previously shown to significantly reduce bleeding complications at the cost of a modest increase in ischemic events compared with unfractionated heparin (UFH) and glycoprotein IIb/IIIa inhibitors (GPIs). However, the excess bleeding in patients treated with UFH and GPIs may have been caused by excessively high UFH doses and increased activated clotting times. This study sought to determine the bleeding risk of targeted low-dose UFH with GPIs compared with bivalirudin in patients undergoing elective PCI. Of 1,205 patients undergoing elective PCI, 602 underwent PCI with adjunctive UFH and GPIs with the UFH dose targeted to an activated clotting time of approximately 250 seconds, and 603 patients matched for baseline characteristics underwent PCI with bivalirudin. Outcomes were analyzed for major bleeding (hematocrit decrease >15%, gastrointestinal bleed, or major hematoma) and 6-month major adverse cardiac events (death, myocardial infarction, and target-lesion revascularization). The maximum activated clotting time achieved was 261.7 ± 61.6 seconds in the UFH/GPI group and 355.4 ± 66.6 in the bivalirudin group (p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2008.03.030