Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial

Li, Yang; Liang, Zhenyang; Qin, Lei; Wang, Mian; Wang, Xianzhao; Zhang, Huanyi; Liu, Yin; Li, Yan; Jia, Zhisheng; Liu, Limin; Zhang, Hongyan; Luo, Jun; Dong, Songwu; Guo, Jincheng; Zhu, Hengqing; Li, Shengli; Zheng, Hongbo; Liu, Lijun; Wu, Yanqing; Ye, Zhong; Qiu, Miaohan; Han, Yaling; Stone, Gregg W.

doi:10.1016/s0140-6736(22)01999-7

Cited by 63 publications

(32 citation statements)

References 29 publications

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“…Therefore, no significant 6 Cardiovascular Therapeutics difference in our study was found between bivalirudin and heparin due to the limited sample size, which led to a low event number of ST. Recently, the newest BRIGHT-4 study with a total sample size of more than 6000 patients with STEMI showed that bivalirudin with a prolonged infusion post-PCI significantly decreased the rate of ST compared with heparin, indicating that bivalirudin has a substantial effect on preventing ST, to some extent, settled down this dispute [20]. Several limitations should be acknowledged in the present study.…”

Section: Cardiovascular Therapeuticsmentioning

confidence: 75%

“…Similarly, in a pooled analysis of the REPLACE-2, ACUITY, and HORIZONS-AMI trials, bivalirudin was associated with reduced 1-year mortality in patients with DM [19]. Moreover, the most recently published randomized trial, the BRIGHT-4 study, found that bivalirudin with a prolonged infusion significantly reduced the 30-day mortality of patients with ST-segment elevation myocardial infarction undergoing PCI in comparison with heparin monotherapy [20]. The lower rate of death associated with bivalirudin use in patients with DM may have several explanations.…”

Section: Discussionmentioning

confidence: 91%

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Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study

Chen

Yang

et al. 2022

Cardiovascular Therapeutics

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Introduction. Optimal anticoagulants for patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) are unclear. This retrospective observational study is aimed at evaluating efficacy and safety of bivalirudin versus unfractionated heparin (UFH) monotherapy in patients with DM undergoing PCI. Methods. A total of 3890 diabetic patients receiving PCI in the General Hospital of Northern Theater Command were divided into the bivalirudin group ( n = 869 ) and the UFH group ( n = 3021 ) according to different anticoagulant therapy regimens. Indication for PCI was in accordance with current guidelines including national cardiovascular data registry. The primary endpoint was 30-day net adverse clinical events (NACEs). The secondary endpoints included 30-day major adverse cardiac and cerebral events (MACCEs), bleeding events defined according to the Bleeding Academic Research Consortium (BARC) definition, and stent thrombosis (ST). Patients were matched by propensity score at a ratio of 1 : 1. Results. After propensity score matching, the bivalirudin group was associated with a lower incidence of NACEs (3.0% vs. 6.0%, P = 0.003 ) than the UFH group. The incidence of MACCE (1.7% vs. 3.3%, P = 0.033 ) was significantly lower in the bivalirudin group, mainly due to a lower mortality rate (0.6% vs. 2.0%, P = 0.010 ). In addition, patients in the bivalirudin group had less bleeding (1.4% vs. 3.0%, P = 0.022 ) than those in the UFH group, although BARC 2, 3, and 5 bleeding (0.1% vs. 0.6%, P = 0.218 ) was numerically lower. Conclusion. In diabetic patients undergoing PCI, bivalirudin was significantly associated with reduced risks of 30-day NACE and MACCE, mainly driven by the lower rates of bleeding and mortality, compared with heparin monotherapy.

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Section: Cardiovascular Therapeuticsmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 91%

Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study

Chen

Yang

et al. 2022

Cardiovascular Therapeutics

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“…The 2010 European Guidelines for myocardial revascularization also recommended that bivalirudin be the first choice in PCI for patients with ACS (Class I recommendation). Recently, a study from China showed that routine continuation of full-dose bivalirudin infusion for 2–4 h (mean 3 h) post-PCI is superior to UFH monotherapy in reducing bleeding and ischemic events at 30 days among patients with STEMI undergoing PPCI [ 16 ]. Bivalirudin has become a commonly used anticoagulant in emergency and elective PCI [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study

Guo

Wang

et al. 2023

Arch Med Sci

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IntroductionThis study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were undergoing primary percutaneous coronary intervention (PPCI).Material and methodsThe study is a prospective, natural, and selective interventional trial based on real-world data for 482 AMI patients.ResultsAt the end of the follow-up, the two groups demonstrated similar major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding rates. After propensity score matching (PSM), the fondaparinux group showed greater advantages in reducing MACCE and bleeding events.ConclusionsThe anticoagulation strategy of bivalirudin bridging fondaparinux seems to be superior to that of bivalirudin bridging enoxaparin in patients with AMI undergoing PPCI.

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“…Bivalirudin is a direct thrombin inhibitor with a short half-life and a significant reduction in bleeding complications. [51] In the MATRIX trial, 7213 ACS patients (56%of STEMI) were enrolled, bivalirudin significantly reduced the risk of bleeding compared to UFH, at the cost of an increased risk of thrombosis in the stent. [52] The ESC guidelines recommend its use in patients with STEMI (IIa, A), especially those at high-risk of bleeding.…”

Section: Anticoagulant Therapymentioning

confidence: 99%

Acute coronary syndrome management in hemophiliacs: How to maintain balance?: A review

Chen

Sha-ning

2023

Medicine

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To analyze existing literature and understand how to balance the minimization of bleeding risk and ensuring adequate anticoagulation during coronary intervention treatment and long-term postoperative anticoagulation in hemophilia patients during the perioperative period, in order to provide guidance for healthcare professionals in developing effective treatment plans. This narrative review will analyze existing studies, case reports, and clinical guidelines to determine the most effective strategies for managing acute coronary syndrome in hemophilia patients. When evaluating the literature, factors such as patient age, medical history, and severity of the condition will be considered. The current management guidelines for acute coronary syndrome in hemophilia patients are not based on systematic evaluation and mainly rely on expert opinions. This article provides a comprehensive analysis of existing literature and recommends coagulation factor replacement therapy before anticoagulation and intervention treatment, as well as personalized anticoagulation treatment during the postoperative period for better management of hemophilia patients with acute coronary syndrome. These recommendations can help healthcare professionals develop more effective treatment plans for hemophilia patients.

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Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial

Cited by 63 publications

References 29 publications

Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study

Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study

Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study

Acute coronary syndrome management in hemophiliacs: How to maintain balance?: A review

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