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Benefit of Bivalirudin Versus Heparin After Transradial and Transfemoral Percutaneous Coronary Intervention

Bivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bival... Full description

Journal Title: The American journal of cardiology 2012, Vol.110 (12), p.1742-1748
Main Author: MacHaalany, Jimmy, MD
Other Authors: Abdelaal, Eltigani, MD , Bataille, Yoann, MD , Plourde, Guillaume, MS , Duranleau-Gagnon, Pierre, BPharm, MSc , Larose, Éric, DVM, MD , Déry, Jean-Pierre, MD , Barbeau, Gérald, MD , Rinfret, Stéphane, MD , Rodés-Cabau, Josep, MD , De Larochellière, Robert, MD , Roy, Louis, MD , Costerousse, Olivier, PhD , Bertrand, Olivier F., MD, PhD
Format: Electronic Article Electronic Article
Language: English
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Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0002-9149
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title: Benefit of Bivalirudin Versus Heparin After Transradial and Transfemoral Percutaneous Coronary Intervention
format: Article
creator:
  • MacHaalany, Jimmy, MD
  • Abdelaal, Eltigani, MD
  • Bataille, Yoann, MD
  • Plourde, Guillaume, MS
  • Duranleau-Gagnon, Pierre, BPharm, MSc
  • Larose, Éric, DVM, MD
  • Déry, Jean-Pierre, MD
  • Barbeau, Gérald, MD
  • Rinfret, Stéphane, MD
  • Rodés-Cabau, Josep, MD
  • De Larochellière, Robert, MD
  • Roy, Louis, MD
  • Costerousse, Olivier, PhD
  • Bertrand, Olivier F., MD, PhD
subjects:
  • Abridged Index Medicus
  • Aged
  • Anticoagulants
  • Anticoagulants - adverse effects
  • Anticoagulants - therapeutic use
  • Antithrombins - adverse effects
  • Antithrombins - therapeutic use
  • Biological and medical sciences
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular
  • Diseases of the cardiovascular system
  • Female
  • Heart attacks
  • Hemorrhage - etiology
  • Heparin - adverse effects
  • Heparin - therapeutic use
  • Hirudins - adverse effects
  • Hospital Mortality
  • Humans
  • Male
  • Medical sciences
  • Middle Aged
  • Mortality
  • Peptide Fragments - adverse effects
  • Peptide Fragments - therapeutic use
  • Percutaneous Coronary Intervention
  • Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
  • Recombinant Proteins - adverse effects
  • Recombinant Proteins - therapeutic use
  • Tertiary Healthcare
  • Treatment Outcome
  • Veins & arteries
ispartof: The American journal of cardiology, 2012, Vol.110 (12), p.1742-1748
description: Bivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bivalirudin compared to UFH monotherapy in patients undergoing transradial PCI are lacking. The present study sought to compare the in-hospital net clinical adverse events, including death, myocardial infarction, target vessel revascularization, and bleeding, for these 2 antithrombotic regimens for all patients at a tertiary care, high-volume radial center. From April 2009 to February 2011, all patients treated with bivalirudin were matched by access site to those receiving UFH. The patients in the bivalirudin group (n = 125) were older (72 ± 13 years vs 66 ± 11 years; p
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleBenefit of Bivalirudin Versus Heparin After Transradial and Transfemoral Percutaneous Coronary Intervention
creatorMacHaalany, Jimmy, MD ; Abdelaal, Eltigani, MD ; Bataille, Yoann, MD ; Plourde, Guillaume, MS ; Duranleau-Gagnon, Pierre, BPharm, MSc ; Larose, Éric, DVM, MD ; Déry, Jean-Pierre, MD ; Barbeau, Gérald, MD ; Rinfret, Stéphane, MD ; Rodés-Cabau, Josep, MD ; De Larochellière, Robert, MD ; Roy, Louis, MD ; Costerousse, Olivier, PhD ; Bertrand, Olivier F., MD, PhD
creatorcontribMacHaalany, Jimmy, MD ; Abdelaal, Eltigani, MD ; Bataille, Yoann, MD ; Plourde, Guillaume, MS ; Duranleau-Gagnon, Pierre, BPharm, MSc ; Larose, Éric, DVM, MD ; Déry, Jean-Pierre, MD ; Barbeau, Gérald, MD ; Rinfret, Stéphane, MD ; Rodés-Cabau, Josep, MD ; De Larochellière, Robert, MD ; Roy, Louis, MD ; Costerousse, Olivier, PhD ; Bertrand, Olivier F., MD, PhD
descriptionBivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bivalirudin compared to UFH monotherapy in patients undergoing transradial PCI are lacking. The present study sought to compare the in-hospital net clinical adverse events, including death, myocardial infarction, target vessel revascularization, and bleeding, for these 2 antithrombotic regimens for all patients at a tertiary care, high-volume radial center. From April 2009 to February 2011, all patients treated with bivalirudin were matched by access site to those receiving UFH. The patients in the bivalirudin group (n = 125) were older (72 ± 13 years vs 66 ± 11 years; p <0.0001), more often had chronic kidney disease (51% vs 30%; p = 0.0012), and more often underwent primary PCI (30% vs 14%, p <0.0037) than the UFH-treated patients (n = 125). A radial approach was used in 71% of both groups. The baseline bleeding risk according to Mehran's score was similar in both groups (14 ± 9 vs 15 ± 8, p = 0.48). In-hospital mortality was 2% in both groups (p = 1.00). No difference in net clinical adverse events or ischemic or bleeding complications was detected between the 2 groups. Bivalirudin reduced both ischemic and bleeding events in femoral-treated patients, but no such clinical benefit was observed in the radial-treated patients. In conclusion, as periprocedural PCI bleeding avoidance strategies have become paramount to optimize the clinical benefit, the interaction between bivalirudin and radial approach deserves additional investigation.
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languageeng
publisherNew York, NY: Elsevier Inc
subjectAbridged Index Medicus ; Aged ; Anticoagulants ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Antithrombins - adverse effects ; Antithrombins - therapeutic use ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Diseases of the cardiovascular system ; Female ; Heart attacks ; Hemorrhage - etiology ; Heparin - adverse effects ; Heparin - therapeutic use ; Hirudins - adverse effects ; Hospital Mortality ; Humans ; Male ; Medical sciences ; Middle Aged ; Mortality ; Peptide Fragments - adverse effects ; Peptide Fragments - therapeutic use ; Percutaneous Coronary Intervention ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Recombinant Proteins - adverse effects ; Recombinant Proteins - therapeutic use ; Tertiary Healthcare ; Treatment Outcome ; Veins & arteries
ispartofThe American journal of cardiology, 2012, Vol.110 (12), p.1742-1748
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1Abdelaal, Eltigani, MD
2Bataille, Yoann, MD
3Plourde, Guillaume, MS
4Duranleau-Gagnon, Pierre, BPharm, MSc
5Larose, Éric, DVM, MD
6Déry, Jean-Pierre, MD
7Barbeau, Gérald, MD
8Rinfret, Stéphane, MD
9Rodés-Cabau, Josep, MD
10De Larochellière, Robert, MD
11Roy, Louis, MD
12Costerousse, Olivier, PhD
13Bertrand, Olivier F., MD, PhD
title
0Benefit of Bivalirudin Versus Heparin After Transradial and Transfemoral Percutaneous Coronary Intervention
1The American journal of cardiology
addtitleAm J Cardiol
descriptionBivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bivalirudin compared to UFH monotherapy in patients undergoing transradial PCI are lacking. The present study sought to compare the in-hospital net clinical adverse events, including death, myocardial infarction, target vessel revascularization, and bleeding, for these 2 antithrombotic regimens for all patients at a tertiary care, high-volume radial center. From April 2009 to February 2011, all patients treated with bivalirudin were matched by access site to those receiving UFH. The patients in the bivalirudin group (n = 125) were older (72 ± 13 years vs 66 ± 11 years; p <0.0001), more often had chronic kidney disease (51% vs 30%; p = 0.0012), and more often underwent primary PCI (30% vs 14%, p <0.0037) than the UFH-treated patients (n = 125). A radial approach was used in 71% of both groups. The baseline bleeding risk according to Mehran's score was similar in both groups (14 ± 9 vs 15 ± 8, p = 0.48). In-hospital mortality was 2% in both groups (p = 1.00). No difference in net clinical adverse events or ischemic or bleeding complications was detected between the 2 groups. Bivalirudin reduced both ischemic and bleeding events in femoral-treated patients, but no such clinical benefit was observed in the radial-treated patients. In conclusion, as periprocedural PCI bleeding avoidance strategies have become paramount to optimize the clinical benefit, the interaction between bivalirudin and radial approach deserves additional investigation.
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0Abridged Index Medicus
1Aged
2Anticoagulants
3Anticoagulants - adverse effects
4Anticoagulants - therapeutic use
5Antithrombins - adverse effects
6Antithrombins - therapeutic use
7Biological and medical sciences
8Cardiology
9Cardiology. Vascular system
10Cardiovascular
11Diseases of the cardiovascular system
12Female
13Heart attacks
14Hemorrhage - etiology
15Heparin - adverse effects
16Heparin - therapeutic use
17Hirudins - adverse effects
18Hospital Mortality
19Humans
20Male
21Medical sciences
22Middle Aged
23Mortality
24Peptide Fragments - adverse effects
25Peptide Fragments - therapeutic use
26Percutaneous Coronary Intervention
27Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
28Recombinant Proteins - adverse effects
29Recombinant Proteins - therapeutic use
30Tertiary Healthcare
31Treatment Outcome
32Veins & arteries
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1Abdelaal, Eltigani, MD
2Bataille, Yoann, MD
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5Larose, Éric, DVM, MD
6Déry, Jean-Pierre, MD
7Barbeau, Gérald, MD
8Rinfret, Stéphane, MD
9Rodés-Cabau, Josep, MD
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titleBenefit of Bivalirudin Versus Heparin After Transradial and Transfemoral Percutaneous Coronary Intervention
authorMacHaalany, Jimmy, MD ; Abdelaal, Eltigani, MD ; Bataille, Yoann, MD ; Plourde, Guillaume, MS ; Duranleau-Gagnon, Pierre, BPharm, MSc ; Larose, Éric, DVM, MD ; Déry, Jean-Pierre, MD ; Barbeau, Gérald, MD ; Rinfret, Stéphane, MD ; Rodés-Cabau, Josep, MD ; De Larochellière, Robert, MD ; Roy, Louis, MD ; Costerousse, Olivier, PhD ; Bertrand, Olivier F., MD, PhD
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1Aged
2Anticoagulants
3Anticoagulants - adverse effects
4Anticoagulants - therapeutic use
5Antithrombins - adverse effects
6Antithrombins - therapeutic use
7Biological and medical sciences
8Cardiology
9Cardiology. Vascular system
10Cardiovascular
11Diseases of the cardiovascular system
12Female
13Heart attacks
14Hemorrhage - etiology
15Heparin - adverse effects
16Heparin - therapeutic use
17Hirudins - adverse effects
18Hospital Mortality
19Humans
20Male
21Medical sciences
22Middle Aged
23Mortality
24Peptide Fragments - adverse effects
25Peptide Fragments - therapeutic use
26Percutaneous Coronary Intervention
27Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
28Recombinant Proteins - adverse effects
29Recombinant Proteins - therapeutic use
30Tertiary Healthcare
31Treatment Outcome
32Veins & arteries
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1Abdelaal, Eltigani, MD
2Bataille, Yoann, MD
3Plourde, Guillaume, MS
4Duranleau-Gagnon, Pierre, BPharm, MSc
5Larose, Éric, DVM, MD
6Déry, Jean-Pierre, MD
7Barbeau, Gérald, MD
8Rinfret, Stéphane, MD
9Rodés-Cabau, Josep, MD
10De Larochellière, Robert, MD
11Roy, Louis, MD
12Costerousse, Olivier, PhD
13Bertrand, Olivier F., MD, PhD
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5Larose, Éric, DVM, MD
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abstractBivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bivalirudin compared to UFH monotherapy in patients undergoing transradial PCI are lacking. The present study sought to compare the in-hospital net clinical adverse events, including death, myocardial infarction, target vessel revascularization, and bleeding, for these 2 antithrombotic regimens for all patients at a tertiary care, high-volume radial center. From April 2009 to February 2011, all patients treated with bivalirudin were matched by access site to those receiving UFH. The patients in the bivalirudin group (n = 125) were older (72 ± 13 years vs 66 ± 11 years; p <0.0001), more often had chronic kidney disease (51% vs 30%; p = 0.0012), and more often underwent primary PCI (30% vs 14%, p <0.0037) than the UFH-treated patients (n = 125). A radial approach was used in 71% of both groups. The baseline bleeding risk according to Mehran's score was similar in both groups (14 ± 9 vs 15 ± 8, p = 0.48). In-hospital mortality was 2% in both groups (p = 1.00). No difference in net clinical adverse events or ischemic or bleeding complications was detected between the 2 groups. Bivalirudin reduced both ischemic and bleeding events in femoral-treated patients, but no such clinical benefit was observed in the radial-treated patients. In conclusion, as periprocedural PCI bleeding avoidance strategies have become paramount to optimize the clinical benefit, the interaction between bivalirudin and radial approach deserves additional investigation.
copNew York, NY
pubElsevier Inc
pmid22980964
doi10.1016/j.amjcard.2012.07.043