Can bivalirudin and provisional GP IIb/IIIa blockade REPLACE heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention?
The combined use of low dose heparin and glycoprotein (GP) IIb/IIIa blockers is standard treatment during percutaneous coronary interventions (PCIs). Bivalirudin has a different mechanism of anticoagulant action than heparin. In REPLACE-2, patients undergoing PCI were randomised to bivalirudin with provisional GP IIb/IIIa blockade or heparin and planned GP IIb/IIIa blockade. The primary quadruple composite end point was death, myocardial infarction, urgent repeat revascularisation or in-hospital major bleeding by 30 days, and statistical analysis showed that bivalirudin was not inferior to heparin plus GP IIb/IIIa blockade. There were fewer major and minor bleeding events with bivalirudin than with heparin plus GP IIb/IIIa blockade. Bivalirudin and provisional GP IIb/IIIa blockade should now be considered as an alternative to heparin plus planned GP IIb/IIIa blockade in patients undergoing urgent or elective revascularisation.
Doggrell
Sheila
S
School of Biomedical Sciences, University of Queensland, QLD 4072, Australia. s_doggrell@yahoo.com
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002986:Clinical Trials as Topic; D003331:Coronary Vessels / Q000601:surgery*; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D010446:Peptide Fragments / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011994:Recombinant Proteins / Q000627:therapeutic use*
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D006629:Hirudins; D007140:Immunoglobulin Fab Fragments; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin; D000077284:Abciximab