title: Bivalirudin compared with IIb/IIIa inhibitors in patients with in-stent restenosis undergoing intracoronary brachytherapy.
abstract: BACKGROUND
  Bivalirudin is replacing heparin in percutaneous coronary interventions (PCIs), including vascular brachytherapy (VBT). The aim of the study was to compare bivalirudin with eptifibatide in patients with in-stent restenosis (ISR) undergoing PCI and VBT.
  
  
  METHODS
  One hundred forty-four patients treated with bivalirudin as a single antithrombotic agent were compared with 150 patients treated with eptifibatide. Bivalirudin as a bolus of 0.75 mg/kg followed by 1.75 mg/kg/h infusion until the end of the procedure, and eptifibatide as a double bolus of 180 microg/kg followed by 2 microg/kg/min infusion for 18 h after the procedure were used. The main outcome measures were in-hospital events and 30-day clinical outcomes.
  
  
  RESULTS
  Baseline clinical characteristics were similar except that patients in the eptifibatide group were younger (P=.02) and had more saphenous vein graft lesions (P<.001). Patients in the bivalirudin group had a higher number of lesions in the right coronary artery (P<.001) and a higher number of vessels treated (P<.001). Postprocedure creatinine phosphokinase (CPK)-MB levels were significantly lower in the bivalirudin group (P<.03). In-hospital events showed significantly less minor bleeding (P=.01) and a trend toward lower major bleeding and major adverse cardiac events (MACE) in the bivalirudin group (P=.06). Thirty-day outcomes showed a significantly lower incidence of non-Q-wave myocardial infarction (MI) in the bivalirudin group (P=.004).
  
  
  CONCLUSIONS
  Bivalirudin, as a single antithrombotic agent during PCI and VBT, is associated with significantly lower postprocedural CPK-MB elevation, minor bleeding complications, 30-day non-Q-wave MI rates, and a trend toward lower major bleeding and in-hospital MACE when compared with eptifibatide.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington DC 20010, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Kuchulakanti
authors.forename: Roswitha
authors.initials: R
authors.lastname: Wolfram
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Edouard
authors.initials: E
authors.lastname: Cheneau
authors.forename: Leonardo
authors.initials: L
authors.lastname: Clavijo
authors.forename: William W
authors.initials: WW
authors.lastname: Chu
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Pinnow
authors.forename: Daniel
authors.initials: D
authors.lastname: Canos
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy; D000077542:Eptifibatide; D005260:Female; D005500:Follow-Up Studies; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D000077542:Eptifibatide; C074619:bivalirudin