Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience.

Rohla, Miklos; Tentzeris, Ioannis; Freynhofer, Matthias K; Farhan, Serdar; Jarai, Rudolf; Egger, Florian; Weiss, Thomas W; Wojta, Johann; Geppert, Alexander; Kastrati, Adnan; Stone, Gregg W; Huber, Kurt

doi:10.1007/s00508-016-1078-6

journal article

Document type:: Journal Article
Author(s):: Rohla, Miklos; Tentzeris, Ioannis; Freynhofer, Matthias K; Farhan, Serdar; Jarai, Rudolf; Egger, Florian; Weiss, Thomas W; Wojta, Johann; Geppert, Alexander; Kastrati, Adnan; Stone, Gregg W; Huber, Kurt
Title:: Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience.
Abstract:: In a retrospective analysis of a prospective single center registry we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) undergoing stent implantation.Bivalirudin was associated with tendentially reduced in-hospital minor or major bleeding rates compared to UFH monotherapy (5.9 % vs. 9.4 % adjusted odds ratio (OR) 0.82, 95 % confidence interval CI 0.45-1.51, p = 0.53) and compared to the pooled UFH group (5.9 % vs. 11.9 %, adjusted OR 0.62, 95 % CI 0.36-1.08, p = 0.09) but with significantly lower bleeding hazards compared to UFH + abciximab (5.9 % vs. 16 %, adjusted OR 0.41, 95 % CI 0.22-0.78, p < 0.01). After 3 years of follow-up, adjusted cardiovascular mortality rates were similar between all groups, particularly between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95 % CI 0.58-2.16, p = 0.73) and vs. UFH + abciximab (HR 0.91, 95 % CI 0.40-2.10, p = 0.83). Acute or subacute stent thrombosis occurred at a rate of 0.8 % with no significant differences between the groups.This retrospective analysis in a real world situation of medium to high-risk ACS patients undergoing invasive revascularization confirmed the results of most large-scale randomized trials by demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but with no significant differences between treatment strategies for long-term all-cause and cardiovascular mortality.
Journal title abbreviation:: Wien Klin Wochenschr
Year:: 2016
Journal volume:: 128
Journal issue:: 23-24
Pages contribution:: 906-915
Language:: eng
Fulltext / DOI:: doi:10.1007/s00508-016-1078-6
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/27624328
Print-ISSN:: 0043-5325
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2016