Bivalirudin with planned or provisional abciximab versus low-dose heparin and abciximab during percutaneous coronary revascularization: Results of the Comparison of Abciximab Complications with Hirulog for Ischemic Events Trial (CACHET)

Lincoff, A. Michael; Kleiman, Neal S.; Kottke-Marchant, Kandace; Maierson, Elizabeth S.; Maresh, Kelly; Wolski, Katherine E.; Topol, Eric J.

doi:10.1067/mhj.2002.122173

Cited by 161 publications

(111 citation statements)

References 21 publications

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“…Furthermore, in PCI cases using bivalirudin the ACT has been shown to have no correlation with myocardial ischemia and bleeding complications. 45,46,72,73 Due to the differences in ACT systems in use and their variable response to bivalirudin, new technologies have developed to improve bivalirudin monitoring during cardiac surgery. Preliminary evidence indicates that the ACTT (a modified ACT with improved clotting time linearity to high bivalirudin concentrations) correlates with low and high plasma concentrations of bivalirudin in this setting.…”

Section: Monitoring Bivalirudin Anticoagulation During Cardiac Surgerymentioning

confidence: 99%

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Bivalirudin use for anticoagulating patients undergoing cardiac surgery, particularly those with or at risk for heparin-induced thrombocytopenia, has expanded over the past several years. The purpose of this review is to provide a summary of the following: the differences between indirect and direct thrombin inhibition, unfractionated heparin's limitations (i.e., heparin-induced thrombocytopenia), bivalirudin's pharmacology, recent cardiac surgery trials comparing bivalirudin and unfractionated heparin as anticoagulants, the growing role of bivalirudin-mediated anticoagulation for various surgical procedures, and the potential of bivalirudin-mediated vascular graft patency.

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Section: Monitoring Bivalirudin Anticoagulation During Cardiac Surgerymentioning

confidence: 99%

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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“…International Journal of Cardiology j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j c a rd to heparin plus GP IIb/IIIa [9][10][11][12][13]. However, several of these studies were noninferiority trials and not designed to demonstrate a difference in clinical events [9][10][11].…”

mentioning

confidence: 99%

Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: A meta-analysis of randomized clinical trials

Lee

Liao

Yang

et al. 2011

International Journal of Cardiology

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Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: a meta-analysis of randomized clinical trials. Objective: This meta-analysis was performed to assess the efficacy and safety of bivalirudin compared with unfractionated heparin or enoxaparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI). Background: Pharmacotherapy for patients undergoing PCI includes bivalirudin, heparin, and GP IIb/IIIa inhibitors. We sought to compare ischemic and bleeding outcomes with bivalirudin versus heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI. Methods: A literature search was conducted to identify fully published randomized trials that compared bivalirudin with heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI. Results: A total of 19,772 patients in 5 clinical trials were included in the analysis (9785 patients received bivalirudin and 9987 patients received heparin plus GP IIb/IIIa inhibitors during PCI). Anticoagulation with bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in no difference in major adverse cardiovascular events (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.96 to 1.19), death (OR 0.93, 95% CI 0.72 to 1.21), or urgent revascularization (OR 1.06, 95% CI 0.86 to 1.30). There is a trend towards a higher risk of myocardial infarction (OR 1.12, 95% CI 0.99 to 1.28) but a significantly lower risk of TIMI major bleeding with bivalirudin (OR 0.55, 95% CI 0.44 to 0.69). Conclusion: In patients who undergo PCI, anticoagulation with bivalirudin as compared with unfractionated heparin or enoxaparin plus GP IIb/IIIa inhibitors results in similar ischemic adverse events but a reduction in major bleeding.

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“…In a pilot trial called the Comparison of Abciximab Complications with Hirulog for Ischemic Events (CACHET) trial, 268 patients were randomized to receive bivalirudin (with or without abciximab) or abciximab with low-dose weight-adjusted heparin during PCI. 100 In this study, bivalirudin with planned or provisional abciximab was as safe and effective as low-dose heparin plus abciximab. In a separate trial called the Protection against Post-PCI Microvascular Dysfunction and Post-PCI Ischemia among Anti-Platelet and Anti-Thrombotic AgentsThrombolysis in Myocardial Infarction (PROTECT-TIMI)-30 trial, 857 patients with non-STEMI were randomized to one of three regimens following angiography: eptifibatide + reduced-dose unfractionated heparin, eptifibatide + reduced dose low-molecular-weight heparin, or bivalirudin monotherapy.…”

Section: Role Of Bivalirudinmentioning

confidence: 90%

Selecting the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention

Parikh

Keeley

2009

VHRM

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Abstract:The wide variety of anticoagulant and antiplatelet agents available for clinical use has made choosing the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention a complex task. While there is no single best regimen, from a risk-benefit ratio standpoint, particular regimens may be considered optimal for different patients. We review the mechanisms of action for the commonly prescribed antithrombotic medications, summarize pertinent data from randomized trials on their use in acute coronary syndromes, and provide an algorithm (incorporating data from these trials as well as risk assessment instruments) that will help guide the decision-making process.

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Bivalirudin with planned or provisional abciximab versus low-dose heparin and abciximab during percutaneous coronary revascularization: Results of the Comparison of Abciximab Complications with Hirulog for Ischemic Events Trial (CACHET)

Cited by 161 publications

References 21 publications

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: A meta-analysis of randomized clinical trials

Selecting the optimal antithrombotic regimen for patients with acute coronary syndromes undergoing percutaneous coronary intervention

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