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Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction.
Department of Cardiology, Lund University, Sweden.
Department of Cardiology, Lund University, Sweden.
Department of Cardiology, Sahlgrenska University Hospital, Sweden.
Department of Cardiology, Örebro University, Sweden.
Vise andre og tillknytning
2018 (engelsk)Inngår i: European Heart Journal. Acute Cardiovascular Care, ISSN 2048-8734Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

Background: The optimal anti-coagulation strategy for patients with non-ST-elevation myocardial infarction treated with percutaneous coronary intervention is unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non-ST-elevation myocardial infarction without routine glycoprotein IIb/IIIa inhibitor use.less thanbr /greater thanMethods: In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention, treated with ticagrelor or prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarction or major bleeding within 180 days.less thanbr /greater thanResults: A total of 3001 patients with non-ST-elevation myocardial infarction, were enrolled. The primary endpoint occurred in 12.1% (182 of 1503) and 12.5% (187 of 1498) of patients in the bivalirudin and heparin groups, respectively (hazard ratio of bivalirudin compared to heparin treatment 0.96, 95% confidence interval 0.78-1.18, p=0.69). The results were consistent in all major subgroups. All-cause death occurred in 2.0% versus 1.7% (hazard ratio 1.15, 0.68-1.94, p=0.61), myocardial infarction in 2.3% versus 2.5% (hazard ratio 0.91, 0.58-1.45, p=0.70), major bleeding in 8.9% versus 9.1% (hazard ratio 0.97, 0.77-1.24, p=0.82) and definite stent thrombosis in 0.3% versus 0.2% (hazard ratio 1.33, 0.30-5.93, p=0.82).less thanbr /greater thanConclusion: Bivalirudin as compared to heparin during percutaneous coronary intervention for non-ST-elevation myocardial infarction did not reduce the composite of all-cause death, myocardial infarction or major bleeding in non-ST-elevation myocardial infarction patients receiving current recommended treatments with modern P2Y12-inhibitors and predominantly radial access.

sted, utgiver, år, opplag, sider
Sage Publications, 2018.
Emneord [en]
Bivalirudin; heparin; non-ST-elevation myocardial infarction
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-155804DOI: 10.1177/2048872618805663PubMedID: 30281320OAI: oai:DiVA.org:liu-155804DiVA, id: diva2:1299630
Forskningsfinansiär
Swedish Heart Lung FoundationSwedish Research CouncilSwedish Foundation for Strategic Research Tilgjengelig fra: 2019-03-28 Laget: 2019-03-28 Sist oppdatert: 2019-03-28

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