title: Heparin Versus Bivalirudin in ST-Segment Elevation Myocardial Infarction: A SCAI-Based National Survey From US Interventional Cardiologists.
abstract: BACKGROUND
  The use of antithrombotic therapy (ATT) (bivalirudin or unfractionated heparin) is a class I recommendation for patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). This survey was conducted to better understand current United States (US) practices in terms of preferences regarding the selection of ATT in STEMI-PPCI, particularly in light of recent clinical trials.
  
  
  METHODS
  An electronic survey consisting of 9 focused questions was forwarded to 2676 US interventional cardiologists who were members of the Society for Cardiovascular Angiography and Interventions (SCAI).
  
  
  RESULTS
  Among 390 responders (14.5%), bivalirudin with bail-out glycoprotein IIb/IIIa inhibitor (GPI) was the predominant strategy for 53% of operators, whereas 32% preferred heparin with bail-out GPI and 15% preferred heparin with more routine GPI. The duration of bivalirudin infusion varied widely among operators, and significant variability existed in the bolus dose of heparin that was preferred by operators. About 49% of respondents stated that the choice of ATT was not affected by the bleeding risk of the patient, although access site did appear to affect the choice of ATT for some operators. Notably, 43% of operators reported to have changed their practice regarding ATT in light of recent trial results.
  
  
  CONCLUSIONS
  There is marked variability in self-reported ATT use in STEMI-PPCI among US interventional cardiologists. Given the patient-related variability in bleeding risk and mixed clinical trial results between the two predominant ATT agents, bivalirudin and unfractionated heparin, more data are needed in order to further inform and potentially unify clinical practice in STEMI-PPCI.
authors: Harsh
authors: H
authors: Golwala
authors: Sadip
authors: S
authors: Pant
authors: Ambarish
authors: A
authors: Pandey
authors: Michael P
authors: MP
authors: Flaherty
authors: Glenn A
authors: GA
authors: Hirsch
authors: Center for Interventional Vascular Therapy, Columbia University Medical Center/New York Presbyterian Hospital, 161 Fort Washington Ave, 6th Floor, New York, NY 10032 USA. akirtane@columbia.edu.
authors: Ajay J
authors: AJ
authors: Kirtane
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D000072096:Cardiologists / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D015642:Radiology, Interventional / Q000592:standards / Q000639:trends*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin