title: Safety of the primary percutaneous coronary intervention strategy combining pre-hospital prasugrel, enoxaparin and in-hospital bivalirudin in acute ST-segment elevation myocardial infarction.
abstract: The optimal antithrombotic treatment during a primary percutaneous coronary intervention (pPCI) is not known. This single center registry study aims to assess the safety of a novel antithrombotic regimen combining enoxaparine and prasugrel at presentation, followed by bivalirudin at the catheterisation laboratory.
  
  
  
  All consecutive patients who underwent a pPCI were collected prospectively. The primary endpoint was major bleeding within 30 days. The secondary endpoints were a composite of major adverse cardiovascular events (MACE) consisting of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, a new target vessel revascularisation and all-cause mortality at 30 days.
  
  
  
  Ninety-nine out of the total of 390 patients were treated according to the new regimen (protocol-treated group). The rest received other antithrombotic treatment (non-protocol-treated group). The protocol-treated group had a lower risk than the non-protocol-treated group according to the GRACE ischaemic (112 vs. 124, p = 0.002) and CRUSADE bleeding scores (21 vs. 28, p < 0.0001). The incidences of bleeding were similar: severe GUSTO or TIMI bleeding occurred in 0 % of the protocol-treated group and in 1.0 and 0.3 %, respectively, of the other group (p = 0.311 for GUSTO and p = 0.559 for TIMI). The incidence of MACE in the groups was 6.1 and 10.7 %, respectively (p = 0.178). The respective incidences of all-cause mortality were 5.1 and 9.6 % (p = 0.158).
  
  
  
  Administration of the novel antithrombotic regimen seems to be safe.
authors.affiliation: Department of Cardiology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland. juho.viikila@phsotey.fi.
authors.forename: Juho
authors.initials: J
authors.lastname: Viikilä
authors.affiliation: Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
authors.affiliation: Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Tierala
authors.affiliation: Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage; D002423:Cause of Death / Q000639:trends; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D017984:Enoxaparin; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D000068799:Prasugrel Hydrochloride; C074619:bivalirudin