Bivalirudin with provisional glycoprotein IIb/IIIa inhibitors in patients undergoing primary angioplasty in the setting of cardiogenic shock.
In patients undergoing percutaneous coronary intervention (PCI), clinical trials have demonstrated that the use of bivalirudin with provisional glycoprotein IIb/IIIa inhibitors is not inferior to heparin with systematic glycoprotein IIb/IIIa inhibitors on major adverse cardiac events and is associated with lower rates of bleeding in various clinical settings. Patients with cardiogenic shock (CS), however, have been excluded from all pivotal trials. A retrospective analysis of 86 consecutive patients undergoing PCI for acute myocardial infarction complicated by CS in our center from April 2003 to September 2007 was performed. In-hospital death, major adverse cardiac events, and bleeding rates were compared in 37 patients who received bivalirudin with or without glycoprotein IIb/IIIa inhibitors and 49 patients who were treated with heparin and glycoprotein IIb/IIIa inhibitors as anticoagulation management. Baseline demographic, clinical, and biological characteristics were similar in the 2 groups. The in-hospital death rate was significantly lower in the bivalirudin group (5.4 vs 32.7%, p = 0.002). There were no differences in the rate of major hematoma between the bivalirudin group and the heparin group (3 vs 2.6%, p = 0.46). In conclusion, bivalirudin with provisional use of glycoprotein IIb/IIIa inhibitors appears to be a safe and effective anticoagualtion strategy in patients undergoing primary PCI for acute myocardial infarction complicated by CS.
Bonello
Laurent
L
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
De Labriolle
Axel
A
Roy
Probal
P
Steinberg
Daniel H
DH
Pinto Slottow
Tina L
TL
Xue
Zhenyi
Z
Smith
Kimberley
K
Torguson
Rebecca
R
Suddath
William O
WO
Satler
Lowell F
LF
Kent
Kenneth M
KM
Pichard
Augusto D
AD
Waksman
Ron
R
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D039661:Integrin beta3 / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D010446:Peptide Fragments / Q000008:administration & dosage*; D040201:Platelet Membrane Glycoprotein IIb / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012770:Shock, Cardiogenic / Q000150:complications*; D016896:Treatment Outcome
D000925:Anticoagulants; D006629:Hirudins; D039661:Integrin beta3; D010446:Peptide Fragments; D040201:Platelet Membrane Glycoprotein IIb; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin