Impact of bivalirudin on outcomes after percutaneous coronary revascularization with drug-eluting stents

Feldman, Dmitriy N.; Wong, S. Chiu; Gade, Christina; Gidseg, David S.; Bergman, Geoffrey; Minutello, Robert M.

doi:10.1016/j.ahj.2007.06.023

Cited by 11 publications

(3 citation statements)

References 23 publications

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“…The ACUITY trial showed that in patients with moderate-or high-risk ACS who were undergoing invasive treatment, use of bivalirudin alone versus UFH plus a GP IIb/IIIa inhibitor was associated with similar rates of death, MI, or revascularization for ischemia and a signifi cantly lower rate of bleeding [29]. Review of the Cornell Angioplasty Registry showed that bivalirudin was noninferior to UFH plus a GP IIb/IIIa inhibitor in suppression of acute ischemic events after DES implantation [30]. There were also fewer bleeding complications and a similar longterm all-cause mortality rate.…”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 96%

Medical therapy in acute coronary syndromes: Which medicines and at what doses?

Kireyev¹,

Yun²,

Page³

et al. 2009

Curr Cardiol Rep

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Acute coronary syndrome (ACS) occurs when plaque rupture in a coronary artery is superimposed with thrombus formation. This accounts for 1.7 million hospital admissions in the United States annually and significant morbidity and mortality. Although there are advantages to an invasive approach to treating patients with ACS, the role of medical therapy is vital as an adjunctive treatment to reperfusion therapies and in stabilizing ruptured plaques and modifying the metabolic milieu that predisposes to plaque formation and rupture. This article reviews the most important drug classes for medical treatment of ACS patients, as well as optimal doses. This is an exciting time to be involved in the field of cardiovascular medicine, as we continue to see profound improvement from medical therapy in the morbidity and mortality associated with ACS.

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Section: Direct Thrombin Inhibitorsmentioning

confidence: 96%

Medical therapy in acute coronary syndromes: Which medicines and at what doses?

Kireyev¹,

Yun²,

Page³

et al. 2009

Curr Cardiol Rep

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show abstract

“…Some studies found that bivalirudin use to be noninferior to treatment with heparin plus glycoprotein IIb/IIIa inhibitors [33,34]. Furthermore, bleeding complications were less frequently seen in patients with periprocedural bivalirudin therapy than in patients with heparin plus glycoprotein IIb/IIIa inhibitors [34]. Thus, in this context, bivalirudin has a beneficial effect.…”

Section: Glycoprotein Iib/iiia Inhibitorsmentioning

confidence: 99%

Pharmacological Prevention of Peri-, and Post-Procedural Myocardial Injury in Percutaneous Coronary Intervention

Ishii¹,

Amano²,

Murohara

2008

CCR

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In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

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“…In a large single-centre registry of patients treated with DES, all-cause mortality over two years of follow-up was significantly lower in those individuals who received peri-procedural heparin plus GPIIb/IIIa inhibitor therapy compared with those treated with bivalirudin. 80 The potential inadequacy of bivalirudin monotherapy in patient cohorts with high levels of baseline platelet activation (acute myocardial infarction, diabetes, etc.) was observed in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial infarction (HORIZONS-AMI) trial, which compared bivalirudin with unfractionated heparin plus GPIIb/IIIa blockade in patients undergoing primary PCI for ST-segment elevation myocardial infarction.…”

Section: Peri-procedural Adjunctive Pharmacotherapiesmentioning

confidence: 99%