May 26, 2014European Heart Journal
Balancing the risks of stent thrombosis and major bleeding during primary percutaneous coronary intervention
Why the study?
Does bivalirudin reduce the composite of death or major bleeding compared to heparins with routine or bailout GPI use in patients with STEMI undergoing primary PCI?
Population
2,198 patients presenting with ST-segment elevation acute coronary syndrome transported emergently for…
Comparison
Bivalirudin. vs Heparins with routine glycoprotein IIb/IIIa…
Design
Editorial, open label
Authors
Discussion
Loading...
Member takes
Implication
Bivalirudin reduces major bleeding compared to heparins with glycoprotein IIb/IIIa inhibitors in primary PCI for STEMI, but at the cost of an increased risk of acute stent thrombosis.
Structured PICO
Does bivalirudin reduce the composite of death or major bleeding compared to heparins with routine or bailout GPI use in patients with STEMI undergoing primary PCI?
P
Population
2,198 patients presenting with ST-segment elevation acute coronary syndrome (STE-ACS) transported emergently for primary percutaneous coronary intervention (EUROMAX trial population).
I
Intervention
Bivalirudin (pre-hospital initiation, with continuation of low-dose 0.25 mg/kg/h or PCI dose 1.75 mg/kg/h for at least 4 h post-PCI).
C
Comparator
Heparins (unfractionated heparin or low-molecular weight heparin) with routine glycoprotein IIb/IIIa inhibitor (GPI) use (initiated before or during coronary angiography) or heparins with bailout GPI use (initiated after the start of PCI).
O
Outcome
Composite primary endpoint of death or major bleeding.composite
Bivalirudin reduces major bleeding compared to heparins with glycoprotein IIb/IIIa inhibitors in primary PCI for STEMI, but at the cost of an increased risk of acute stent thrombosis.
Limitations
- post-randomization analysis
- open label trial design
Cite This Study
Gutiérrez et al. (2014) studied this question.