title: Bivalirudin use and one-month outcome in the context of contemporary antiplatelet treatment: insights from the Greek Antiplatelet Registry.
abstract: OBJECTIVE
  Little is known about the use of bivalirudin in "real life". In the context of contemporary antiplatelet treatment, we aimed to assess bivalirudin treatment patterns and short-term (one-month) outcome.
  
  
  METHODS
  Greek Antiplatelet Registry (GRAPE) is a prospective, observational, multicenter cohort study of consecutive, moderate-to-high-risk acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). We assessed bivalirudin treatment patterns and predictive factors for its use. Combined in-hospital and one-month major adverse cardiovascular events (MACE, including death, myocardial infarction, urgent revascularization, and stroke), and bleeding events according to Bleeding Academic Research Consortium (BARC) criteria were analyzed after propensity matching.
  
  
  RESULTS
  Of 2047 registered patients, 480 (23.4%) were treated with bivalirudin. Multivariate analysis (C statistic 0.77, 0.75-0.80 95% CIs, P < 0.001) revealed as factors favoring bivalirudin use primary PCI, radial arterial access, presentation with positive biomarkers and use of novel P2Y12 inhibitor, whereas IIb/IIIa inhibitor administration did not. Regional trends also affected bivalirudin's choice. In 370 propensity-matched pairs of patients who received or not bivalirudin, MACE, BARC type 1, 2 and 3 did not differ between groups: 4.1%, 21.9%, 3.2%, 3.5% and 5.1%, 18.9%, 2.7%, 4.3%, respectively, P = nonsignificant for all.
  
  
  CONCLUSIONS
  In a "real life", contemporary antiplatelet treatment registry, clinical, laboratory and logistic factors affect bivalirudin's choice, while there are no differences in one-month outcome between bivalirudin-treated and non-bivalirudin-treated patients.
authors: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors: Dimitrios
authors: D
authors: Alexopoulos
authors: Ioanna
authors: I
authors: Xanthopoulou
authors: Spyridon
authors: S
authors: Deftereos
authors: George
authors: G
authors: Sitafidis
authors: Ioannis
authors: I
authors: Kanakakis
authors: Michalis
authors: M
authors: Hamilos
authors: George
authors: G
authors: Karayannis
authors: Christos
authors: C
authors: Angelidis
authors: Katerina
authors: K
authors: Stavrou
authors: Manolis
authors: M
authors: Vavuranakis
authors: John A
authors: JA
authors: Goudevenos
authors: Christodoulos
authors: C
authors: Stefanadis
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006115:Greece; D006470:Hemorrhage / Q000139:chemically induced; D006629:Hirudins / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Antiplatelets; Bivalirudin; Coagulation/ Thrombosis; Interventional cardiology