Key result
Direct thrombin inhibitors reduce 30-day death or MI ~38% vs heparin in early PCI.
Why the study?
The effect of direct thrombin inhibitors compared with heparin in patients undergoing early PCI for acute coronary syndromes was uncertain.
Do direct thrombin inhibitors reduce death or myocardial infarction compared to heparin in patients with acute coronary syndromes undergoing early PCI?
Meta-Analysis (n=35,970)
Yes
Do direct thrombin inhibitors reduce death or myocardial infarction compared to heparin in patients with acute coronary syndromes undergoing early PCI?
Direct thrombin inhibitors are more effective than heparin in reducing 30-day death or myocardial infarction in patients with acute coronary syndromes undergoing early PCI.
Answers are grounded in this paper and cite their sources.
Supports preferring direct thrombin inhibitors over heparin in early PCI for ACS; reinforces prior RCT evidence.
AIMS: We evaluated the effect of direct thrombin inhibitors (DTIs) in patients undergoing early percutaneous coronary intervention (PCI), using the DTI Trialists' Collaboration database of 35,970 patients from 11 randomized trials of DTIs vs. heparin. METHODS AND RESULTS: We performed a Cox proportional hazards regression analysis with PCI as a time-dependent covariate to assess the independent impact of DTIs according to the performance of early PCI. PCI was performed in 7049 patients in the first 72 h after randomization. In trials in which PCI was not planned, DTIs were associated with a 10% relative risk reduction in death or myocardial infarction at 30 days (HR=0.90, 95% CI: 0.84-0.97). This benefit was found to be greater in patients undergoing early PCI (HR=0.66, 95% CI: 0.48-0.91) than those undergoing non-early PCI (HR=0.94, 95% CI: 0.86-1.03). After adjustment for baseline characteristics and propensity to undergo PCI, the risk of death or myocardial infarction remained lower with DTI (HR=0.62, 95% CI: 0.44-0.89). CONCLUSION: After adjustment for baseline differences and propensity to undergo early PCI, DTIs appeared to be more effective than heparin in reducing death or re-infarction among patients undergoing early PCI.
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Sinnaeve et al. (2005) conducted a meta-analysis in Acute coronary syndromes (n=35,970). Direct thrombin inhibitors (DTIs) vs. Heparin was evaluated on Death or myocardial infarction at 30 days (HR 0.62, 95% CI 0.44-0.89). Direct thrombin inhibitors reduced the risk of death or myocardial infarction at 30 days compared to heparin in patients undergoing early PCI.
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