Impact of anticoagulation regimen prior to revascularization in patients with non-ST-segment elevation acute coronary syndromes: The ACUITY trial.
OBJECTIVE
To evaluate the impact of antithrombotic regimens during the medical phase of treatment among 13,819 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) treated with an early invasive strategy in the acute catheterization and urgent intervention triage strategy (ACUITY) trial.


RESULTS
Endpoints included composite major adverse cardiac events (MACE), major bleeding, and net adverse clinical events (NACE; MACE or major bleeding). The median (interquartile range) duration of antithrombin use in the medical only treatment phase was 6.5 (1.8-22.5) hours. MACE, major bleeding, and NACE during the medical only phase occurred in 63 (0.5%), 117 (0.9%), and 178 (1.3%) patients, respectively. MACE rates in the medical-treatment-only phase were not significantly different between the four randomized medical regimens used (heparin alone, bivalirudin alone, heparin plus a glycoprotein IIb/IIIa inhibitor [GPI], and bivalirudin plus GPI) (Ptrend  = 0.65). The lowest rates of major bleeding and NACE during the medical treatment phase occurred in patients treated with bivalirudin alone (Ptrend  = 0.0006 and Ptrend  = 0.0004, respectively).


CONCLUSIONS
In patients with NSTE-ACS undergoing an early invasive strategy, treatment with bivalirudin alone significantly reduced major bleeding and improved net clinical outcomes during the upstream medical management phase with comparable rates of MACE. © 2015 Wiley Periodicals, Inc.
Department of Cardiology, University Hospital Tübingen, Tübingen, Germany.
Tobias
T
Geisler
Department of Cardiology, University Hospital Tübingen, Tübingen, Germany.
Michal
M
Droppa
Department of Cardiology, University Hospital Tübingen, Tübingen, Germany.
Meinrad
M
Gawaz
Scripps Translational Science Institute, La Jolla, California.
Steven R
SR
Steinhubl
Lille Heart Institute, Lille, France.
Michel E
ME
Bertrand
Cleveland Clinic, Cleveland, Ohio.
A Michael
AM
Lincoff
Hospital Universitari De Bellvitge, IDIBELL, Universitat De Barcelona, Barcelona, Spain.
Angel R
AR
Cequier
University Hospital, Leuven, Belgium.
Walter
W
Desmet
Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark.
Lars H
LH
Rasmussen
Wake Forest University Baptist Medical Center, Wake Forest University, Winston-Salem, North Carolina.
James W
JW
Hoekstra
The Medicines Company, Parsippany, New Jersey.
Debra
D
Bernstein
The Medicines Company, Parsippany, New Jersey.
Efthymios N
EN
Deliargyris
Cardiovascular Research Foundation, New York, New York.|Icahn School of Medicine at Mount Sinai, New York, New York.
Roxana
R
Mehran
Cardiovascular Research Foundation, New York, New York.|Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York.
Gregg W
GW
Stone
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D017984:Enoxaparin; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C074619:bivalirudin
acute coronary syndrome; bivalirudin; coronary artery disease; glycoprotein IIb/IIIa inhibitors; medical management