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Anticoagulation in PCI

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https://www.readbyqxmd.com/read/28303632/the-comparative-safety-and-effectiveness-of-bivalirudin-versus-heparin-monotherapy-in-patients-on-dialysis-undergoing-percutaneous-coronary-intervention-insights-from-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium
#1
Devraj Sukul, Milan Seth, Theodore Schreiber, Akshay Khandelwal, Louis A Cannon, Thomas A LaLonde, Hitinder S Gurm
BACKGROUND: Dialysis patients are at a higher risk of bleeding after percutaneous coronary intervention (PCI); however, due to their exclusion from randomized clinical trials, the optimal antithrombotic regimen for this population remains unknown. We sought to evaluate the comparative safety and effectiveness of bivalirudin monotherapy versus unfractionated heparin (UFH) monotherapy in dialysis patients undergoing PCI. METHODS: We included dialysis patients who underwent PCI in a multicenter registry between January 2010 and September 2015 at 47 Michigan hospitals...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28291727/bivalirudin-versus-heparin-in-women-undergoing-percutaneous-coronary-intervention-a-systematic-review-and-meta-analysis-of-randomized-clinical-trials
#2
Marwan Saad, Ramez Nairooz, Ahmed Rashed, Hesham K Abdelaziz, Amgad Mentias, J Dawn Abbott
BACKGROUND: The anticoagulant of choice during percutaneous coronary intervention (PCI) in women is not well established. METHODS: An electronic search was conducted for trials that randomized patients undergoing PCI to bivalirudin versus heparin, and reported outcomes of interest in women. Random effects DerSimonian-Laird risk ratios (RR) were calculated. Main outcome was net adverse clinical events (NACE) at 30-days. Other outcomes included major adverse cardiac events (MACE), all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), and major bleeding at 30-days...
February 28, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28281731/current-patterns-of-antithrombotic-and-revascularization-therapy-in-patients-hospitalised-for-acute-coronary-syndromes-data-from-the-polish-subset-of-the-epicor-study
#3
Izabela Wojtkowska, Janina Stępińska, Małgorzata Stępień-Wojno, Mateusz Sobota, Jerzy Kopaczewski, Zygfryd Reszka, Michał Kurzelewski, Jesus Medina
BACKGROUND: Cardiovascular disease is the leading cause of mortality and morbidity in developed countries, including Poland. Antithrombotic drugs play a crucial role in the management of acute coronary syndromes (ACS). Recent clinical trials have demonstrated the efficacy and safety profiles of new antiplatelet and anticoagulant agents, which may be used as add-on therapy or replacements for older drugs. The EPICOR: (long-t E: rm follow-u P: of antithrombotic management patterns I: n acute COR: onary syndrome patients) is a prospective international observational study (NCT01171404) designed to describe the use of antithrombotic management strategies for the treatment of ACS during the acute phase and over a follow-up period of up to 2 years from the index event...
March 10, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28279076/triple-antithrombotic-therapy-with-aspirin-p2y12-inhibitor-and-warfarin-after-percutaneous-coronary-intervention
#4
Nathan J Verlinden, James C Coons, Carlo J Iasella, Sandra L Kane-Gill
BACKGROUND: Triple antithrombotic therapy is used in patients who require systemic anticoagulation and undergo percutaneous coronary intervention (PCI) requiring dual antiplatelet therapy. Bleeding with this combination is significant; however, few studies have described outcomes with the use of newer oral P2Y12 inhibitors in this setting. OBJECTIVES: We aimed to compare outcomes among patients prescribed triple therapy with prasugrel or ticagrelor compared to triple therapy with clopidogrel in patients who underwent PCI and required warfarin...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28258727/comparison-of-baseline-characteristics-and-inhospital-outcomes-of-patients-and-use-of-bare-metal-versus-drug-eluting-stents-during-percutaneous-coronary-intervention-2005-to-2015-at-a-single-tertiary-hospital
#5
Romain Didier, Michael A Gaglia, Michael J Lipinski, Edward Koifman, Sarkis Kiramijyan, Smita Negi, Jiaxiang Gai, Rebecca Torguson, Augusto D Pichard, Ron Waksman
With steady growth in the use of drug-eluting stents (DES), the indications for bare metal stents (BMS) have significantly changed over the last decade. This study aims to describe trends in the use of BMS and the evolution of the population receiving them over the past 10 years and determine patient characteristics associated with using BMS. Consecutive patients who underwent percutaneous coronary intervention (PCI) at the Washington Hospital Center from January 2005 through March 2015 were included. Baseline characteristics and inhospital outcomes of patients who underwent PCI with BMS versus DES were compared during 2 different time periods: from 2005 to 2010 and from 2011 to 2015...
February 9, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28230176/antithrombotic-therapy-for-patients-with-stemi-undergoing-primary-pci
#6
REVIEW
Francesco Franchi, Fabiana Rollini, Dominick J Angiolillo
Antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Intravenous anticoagulant drugs available for PPCI include the indirect thrombin inhibitors unfractionated heparin and low-molecular-weight heparin, and the direct thrombin inhibitor bivalirudin. Intravenous antiplatelet drugs mainly include glycoprotein IIb/IIIa inhibitors and the P2Y12-receptor inhibitor cangrelor...
February 23, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28216061/outcomes-after-primary-percutaneous-coronary-intervention-for-st-elevation-myocardial-infarction-caused-by-ectatic-infarct-related-arteries
#7
Vimalraj Bogana Shanmugam, Peter J Psaltis, Dennis T L Wong, Ian T Meredith, Yuvaraj Malaiapan, Wally Ahmar
BACKGROUND: There is minimal published data on outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to an ectatic infarct-related artery (EIRA). The aim of this study was to analyse the clinical characteristics and outcomes of these patients presenting for primary percutaneous coronary intervention (P-PCI) in comparison with non-EIRA. METHODS: Of the 1834 patients who presented at our institution for P-PCI between February 2008 and November 2013, 25 (1...
February 7, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28209184/arterial-access-site-complications-after-use-of-a-vascular-closure-device-related-to-puncture-height
#8
Benjamin Sartorius, Michael Behnes, Melike Ünsal, Ursula Hoffmann, Siegfried Lang, Kambis Mashayekhi, Martin Borggrefe, Ibrahim Akin
BACKGROUND: To analyze differences of access-site complications related to the height of femoral arterial puncture and the use of a vascular closure device (VCD) following percutaneous coronary intervention (PCI). METHODS: A subgroup of the FERARI study being treated by femoral arterial access and valuable inguinal angiography before implantation of a VCD were included. Inguinal angiographies were systematically reviewed by two independent cardiologists to determine the correct height of femoral arterial puncture...
February 16, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28191514/anticoagulant-therapy-for-non-st-segment-elevation-acute-coronary-syndrome-in-china-a-multi-center-observational-study
#9
Xiao-Huan Gong, Jin-Ming Yu, Yong Mao, Da-Yi Hu
OBJECTIVE: To assess the anticoagulant therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in China and to offer the rationale for establishing reasonable strategies to improve the prognosis of NSTE-ACS. METHODS: A total of 1,502 patients with NSTE-ACS were recruited from 28 third-grade hospitals distributed in 14 provinces and cities in China from December 2009 to December 2011. The strategies for diagnosis and treatment, decided by each hospital respectively, were used for further analysis and comparison of medication, percutaneous coronary intervention (PCI), and end points for efficacy and safety assessment at 9 and 30 days following PCI...
April 1, 2016: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/28160375/heparin-versus-bivalirudin-for-non-primary-percutaneous-coronary-intervention-a-post-hoc-analysis-of-the-cport-e-trial
#10
Matthew J Czarny, Chao-Wei Hwang, Daniel Q Naiman, Cynthia C Lemmon, Rani K Hasan, Thomas Wang, Thomas Aversano
OBJECTIVES: To compare bivalirudin to heparin during non-primary percutaneous coronary intervention (PCI). BACKGROUND: The optimal anticoagulant to support PCI remains uncertain. METHODS: We performed a propensity score-based analysis comparing clinical outcomes of patients receiving heparin to those receiving bivalirudin during non-primary PCI. RESULTS: Of 18,867 patients in the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial, we selected 7,913 patients undergoing non-staged PCI of whom 57...
February 4, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28134127/impact-of-presentation-and-transfer-delays-on-complete-st-segment-resolution-before-primary-percutaneous-coronary-intervention-insights-from-the-atlantic-trial
#11
Enrico Fabris, Arnoud Van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Shaun G Goodman, Jurriën M Ten Berg, Leonardo Bolognese, Angel Cequier, Mohamed Chettibi, Christopher J Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F Storey, Uwe Zeymer, Warren J Cantor, Hélène Rousseau, Eric Vicaut, Gilles Montalescot
AIMS: To identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial. METHODS AND RESULTS: ECGs recorded at the time of inclusion [pre-hospital (pre-H)-ECG] and in the catheterization laboratory before angiography (pre-PCI-ECG) were analysed by an independent core laboratory. Complete STR was defined as ≥70%. Complete STR occurred pre-PCI in 12.8% (204/1598) of patients and predicted lower 30-days composite MACCE (OR=0...
January 31, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28116778/percutaneous-coronary-intervention-of-complex-calcified-lesions-with-drug-coated-balloon-after-rotational-atherectomy
#12
Tuomas T Rissanen, Sanna Uskela, Antti Siljander, Jussi M Kärkkäinen, Pirjo Mäntylä, Juha Mustonen, Jaakko Eränen
OBJECTIVES: We investigated the safety and efficacy of PCI using drug-coated balloon (DCB) after rotational atherectomy (rotablation) in a retrospective single center study in patients with calcified de novo coronary lesions. The majority of patients had an increased risk for bleeding. BACKGROUND: DCB has been effective in the treatment of in-stent restenosis, small vessels, and bifurcations. DCB enables short one month dual antiplatelet treatment. No published data exist on the use of DCB after rotablation...
January 23, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28105561/the-rise-and-fall-of-anticoagulation-with-bivalirudin-during-percutaneous-coronary-interventions-a-review-article
#13
REVIEW
Constantinos Andreou, Christos Maniotis, Michael Koutouzis
Bivalirudin is a direct thrombin inhibitor used during percutaneous coronary intervention (PCI). Treatment with bivalirudin compared to heparin plus glycoprotein IIb/IIIa inhibitors (GPI) reduced bleeding complications, but resulted in higher rates of ischemic events, including acute stent thrombosis in ST segment elevation myocardial infarction (STEMI) patients. Thus, it may be considered a reasonable alternative antithrombotic agent in patients at high risk of bleeding undergoing PCI. However its superiority over heparin alone is questioned particularly in the era of novel antiplatelet agents and transradial PCI...
January 19, 2017: Cardiology and Therapy
https://www.readbyqxmd.com/read/28078448/synergic-impact-of-oral-anticoagulation-control-and-renal-function-in-determining-major-adverse-events-in-atrial-fibrillation-patients-undergoing-percutaneous-coronary-intervention-insights-from-the-afcas-registry
#14
Marco Proietti, K E Juhani Airaksinen, Andrea Rubboli, Axel Schlitt, Tuomas Kiviniemi, Pasi P Karjalainen, Gregory Y H Lip
BACKGROUND: In patients with atrial fibrillation (AF), quality of oral anticoagulation control as well as impaired renal function are associated with adverse outcomes. Our objective was to analyze if there was a synergistic impact of these factors in determining adverse outcomes in AF patients undergoing percutaneous coronary intervention and stent (PCI-S). METHODS: Post-hoc analysis from the Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry...
January 11, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28044990/unfractionated-heparin-versus-bivalirudin-in-patients-undergoing-primary-percutaneous-coronary-intervention-a-swedeheart-study
#15
Per Grimfjärd, David Erlinge, Sasha Koul, Bo Lagerqvist, Bodil Svennblad, Christoph Varenhorst, Stefan K James
AIMS: The aim of the study was to compare outcomes in unfractionated heparin (UFH) and bivalirudin-treated patients undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: This observational study contained 20,612 PPCI patients treated with either UFH monotherapy or bivalirudin with or without concomitant UFH. Patients with oral anticoagulant or glycoprotein IIb/IIIa inhibitor (GPI) treatment were excluded. The primary outcome measure was definite early stent thrombosis (ST) that occurred at low and similar rates in UFH only and bivalirudin-treated patients: 0...
March 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/27980542/antithrombotic-management-in-patients-with-percutaneous-coronary-intervention-requiring-oral-anticoagulation
#16
REVIEW
Jarosław Zalewski, Anetta Undas
The dynamic evolution of therapeutic options including the use of vitamin K antagonists (VKA), non-vitamin K oral anticoagulants (NOAC), more potent antiplatelet drugs as well as new generation drug-eluting stents could lead to the view that the current recommendations on the management of patients with percutaneous coronary intervention (PCI) requiring oral anticoagulation do not keep up with the results of several clinical studies published within the last 5 years. In the present overview, we summarize the recent advances in antithrombotic management used in atrial fibrillation patients undergoing PCI for stable coronary artery disease or acute coronary syndrome (ACS)...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/27977592/comparing-the-clinical-outcomes-in-patients-with-atrial-fibrillation-receiving-dual-antiplatelet-therapy-and-patients-receiving-an-addition-of-an-anticoagulant-after-coronary-stent-implantation-a-systematic-review-and-meta-analysis-of-observational-studies
#17
REVIEW
Nabin Chaudhary, Pravesh Kumar Bundhun, He Yan
BACKGROUND: Data regarding the clinical outcomes in patients with atrial fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an anticoagulant in addition to DAPT (DAPT + vitamin K antagonist [VKA]) after coronary stent implantation are still controversial. Therefore, in order to solve this issue, we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT + VKA after percutaneous coronary intervention and stenting (PCI-S). METHODS: Observational studies comparing the adverse clinical outcomes such as major bleeding, major adverse cardiovascular events, stroke, myocardial infarction, all-cause mortality, and stent thrombosis (ST) in AF patients receiving DAPT + VKA therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and PubMed databases...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27959713/prevention-of-bleeding-in-patients-with-atrial-fibrillation-undergoing-pci
#18
RANDOMIZED CONTROLLED TRIAL
C Michael Gibson, Roxana Mehran, Christoph Bode, Jonathan Halperin, Freek W Verheugt, Peter Wildgoose, Mary Birmingham, Juliana Ianus, Paul Burton, Martin van Eickels, Serge Korjian, Yazan Daaboul, Gregory Y H Lip, Marc Cohen, Steen Husted, Eric D Peterson, Keith A Fox
Background In patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain. Methods We randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2...
December 22, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27886817/antithrombotic-therapy-to-reduce-ischemic-events-in-acute-coronary-syndromes-patients-undergoing-percutaneous-coronary-intervention
#19
REVIEW
Freek W A Verheugt
Antithrombotic therapy is essential in the prevention of periprocedural death and myocardial infarction during and after percutaneous coronary intervention. In the pathogenesis of acute coronary syndromes (ACS), both platelets and the coagulation cascade play an important role. Therefore, periprocedural antithrombotic therapy is even more important in ACS than in elective PCI. The most used agents are aspirin, platelet P2Y12 blockers, platelet glycoprotein IIb/IIIa blockers, and parenteral anticoagulants. The P2Y12 blockers must be continued at least 12 months...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27842901/comparison-of-heparin-bivalirudin-and-different-glycoprotein-iib-iiia-inhibitor-regimens-for-anticoagulation-during-percutaneous-coronary-intervention-a-network-meta-analysis
#20
REVIEW
Michael J Lipinski, Regina C Lee, Michael A Gaglia, Rebecca Torguson, Hector M Garcia-Garcia, Augusto D Pichard, Lowell F Satler, Ron Waksman
BACKGROUND/PURPOSE: Numerous GPIs are available for PCI. Although they were tested in randomized controlled trials, a comparison between the different GPI strategies is lacking. Thus, we performed a Bayesian network meta-analysis to compare different glycoprotein IIb/IIIa inhibitor (GPI) strategies with heparin and bivalirudin for percutaneous coronary intervention (PCI). METHODS: MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov were searched by two independent reviewers for randomized controlled trials comparing high-dose bolus tirofiban, abciximab, eptifibatide, heparin with provisional glycoprotein IIb/IIIa inhibitors, and bivalirudin with provisional GPI that reported clinical outcomes...
December 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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