Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Gargiulo G, Carrara G, Frigoli E, Leonardi S, Vranckx P, Campo G, Varbella F, Calabrò P, Zaro T, Bartolini D, Briguori C, Andò G, Ferrario M, Limbruno U, Colangelo S, Sganzerla P, Russo F, Nazzaro MS, Esposito G, Ferrante G, Santarelli A, Sardella G, Windecker S, Valgimigli M. Post-Procedural Bivalirudin Infusion at Full or Low Regimen in Patients With Acute Coronary Syndrome. J Am Coll Cardiol 2019;73:758-74. [PMID: 30784669 DOI: 10.1016/j.jacc.2018.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]

For:	Gargiulo G, Carrara G, Frigoli E, Leonardi S, Vranckx P, Campo G, Varbella F, Calabrò P, Zaro T, Bartolini D, Briguori C, Andò G, Ferrario M, Limbruno U, Colangelo S, Sganzerla P, Russo F, Nazzaro MS, Esposito G, Ferrante G, Santarelli A, Sardella G, Windecker S, Valgimigli M. Post-Procedural Bivalirudin Infusion at Full or Low Regimen in Patients With Acute Coronary Syndrome. J Am Coll Cardiol 2019;73:758-74. [PMID: 30784669 DOI: 10.1016/j.jacc.2018.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]

Number

Cited by Other Article(s)

Li Y, Qi J, Gong Y, Zhou T, Zhang L, Li J, Wang X. Bivalirudin infusion at standard or low regimen during elective percutaneous coronary intervention in high-risk bleeding patients with acute coronary syndrome: Study protocol for a prospective, single-center, randomized controlled trial. Contemp Clin Trials 2025;154:107941. [PMID: 40320071 DOI: 10.1016/j.cct.2025.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 04/29/2025] [Accepted: 05/02/2025] [Indexed: 05/10/2025]

Affiliation(s)

Yue Li National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China; College of Life Science and Biopharmaceutical, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, China
Junxian Qi National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China
Yinghui Gong National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China; College of Life Science and Biopharmaceutical, Shenyang Pharmaceutical University, Shenyang, Liaoning 110016, China
Tienan Zhou National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China
Lei Zhang National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China
Jing Li National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China.
Xiaozeng Wang National Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Rd, Shenyang, Liaoning 110016, China.

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Castiello DS, Buongiorno F, Manzi L, Narciso V, Forzano I, Florimonte D, Sperandeo L, Canonico ME, Avvedimento M, Paolillo R, Spinelli A, Cristiano S, Simonetti F, Semplice F, D’Alconzo D, Vallone DM, Giugliano G, Sciahbasi A, Cirillo P, Gragnano F, Calabrò P, Esposito G, Gargiulo G. Procedural and Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Narrative Review. J Cardiovasc Dev Dis 2025;12:142. [PMID: 40278201 PMCID: PMC12028227 DOI: 10.3390/jcdd12040142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 04/03/2025] [Accepted: 04/05/2025] [Indexed: 04/26/2025] Open

Affiliation(s)

Domenico Simone Castiello Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Federica Buongiorno Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Lina Manzi Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Viviana Narciso Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Imma Forzano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Domenico Florimonte Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Luca Sperandeo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Mario Enrico Canonico Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Marisa Avvedimento Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Roberta Paolillo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Alessandra Spinelli Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Stefano Cristiano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Fiorenzo Simonetti Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Federica Semplice Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Dario D’Alconzo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Donato Maria Vallone Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Giuseppe Giugliano Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Alessandro Sciahbasi Interventional Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy;
Plinio Cirillo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Felice Gragnano Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.G.); (P.C.) Division of Cardiology, Azienda Ospedaliera di Rilievo Nazionale Sant’Anna e San Sebastiano, 81100 Caserta, Italy
Paolo Calabrò Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.G.); (P.C.) Division of Cardiology, Azienda Ospedaliera di Rilievo Nazionale Sant’Anna e San Sebastiano, 81100 Caserta, Italy
Giovanni Esposito Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)
Giuseppe Gargiulo Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (D.S.C.); (F.B.); (L.M.); (V.N.); (I.F.); (D.F.); (L.S.); (M.E.C.); (M.A.); (R.P.); (A.S.); (S.C.); (F.S.); (F.S.); (D.D.); (D.M.V.); (G.G.); (P.C.); (G.E.)

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Jain H, Odat RM, Mody S, Dey D, Singh J, Passey S, Ahmed M, Jain J, Mehta A, Ahmed R. Clinical Outcomes With Postprocedural Anticoagulation Versus No Anticoagulation in Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention: A Meta-Analysis. Cardiol Rev 2025:00045415-990000000-00412. [PMID: 39898654 DOI: 10.1097/crd.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]

Wang Q, Liu Y, Yang L, Zhou T, Zhang Q, Zhang Z, Sun D, Wang X. Reduced-dose of bivalirudin (without the post-procedure infusion) in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention. BMC Cardiovasc Disord 2024;24:713. [PMID: 39702032 DOI: 10.1186/s12872-024-04399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/04/2024] [Indexed: 12/21/2024] Open

Abstract

INTRODUCTION

In clinical practice, the dose of bivalirudin may not be fully applicable to the Chinese population. Therefore, this study aimed to explore the efficacy and safety of a reduced dose (80% of the recommended dose) of bivalirudin without post-procedure infusion for 3-4 h in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI).

METHODS

This was a single-center, retrospective study. Patients who met the inclusion criteria and no exclusion criteria were divided into reduced-dose and recommended-dose groups for analysis. Confounders were corrected using propensity score matching. The incidence of net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding events were observed 30 days postoperatively.

RESULTS

In total, 1,590 patients (795 per group) were obtained after propensity score matching. The results after propensity score matching were as follows: The activated clotting time (ACT) after 5 min in the reduced-dose group was 349.37 ± 47.59 s, which was statistically lower than that in the recommended-dose group, 353.12 ± 44.98 s (P = 0.024). There was no significant difference in the proportion of ACT values of ≥ 250 s after 5 min between the two groups (P > 0.05). There were no significant differences in NACE, MACE, and BARC type 2-5 bleeding events between the two groups (5.0% vs. 4.5%, P = 0.638; 0.0% vs. 0.1%, P = 1.000; 0.3% vs. 0.5%, P = 0.687). There were no statistically significant differences in cumulative NACE and cumulative bleeding events between the two groups at 30 days (P = 0.635 and P = 0.716, respectively).

CONCLUSION

In patients with UA and NSTEMI undergoing elective PCI, 80% of the recommended dose of bivalirudin without post-procedure infusion can be used for anticoagulation without increasing the risk of thrombosis and bleeding.

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Andò G, Micari A, Costa F. Advances in Acute Coronary Syndromes: Bridging Gaps in Diagnosis and Treatment. J Clin Med 2024;13:6003. [PMID: 39408063 PMCID: PMC11478324 DOI: 10.3390/jcm13196003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/05/2024] [Accepted: 10/07/2024] [Indexed: 10/20/2024] Open

Yan Y, Guo J, Wang X, Wang G, Fan Z, Yin D, Wang Z, Zhang F, Tian C, Gong W, Liu J, Lu J, Li Y, Ma C, Vicaut E, Montalescot G, Nie S. Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial. Circulation 2024;149:1258-1267. [PMID: 38406848 DOI: 10.1161/circulationaha.123.067079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024]

Abstract

BACKGROUND

Postprocedural anticoagulation (PPA) is frequently administered after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction, although no conclusive data support this practice.

METHODS

The RIGHT trial (Comparison of Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After Primary PCI) was an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted at 53 centers in China. Patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomly assigned by center to receive low-dose PPA or matching placebo for at least 48 hours. Before trial initiation, each center selected 1 of 3 PPA regimens (40 mg of enoxaparin once daily subcutaneously; 10 U·kg·h of unfractionated heparin intravenously, adjusted to maintain activated clotting time between 150 and 220 seconds; or 0.2 mg·kg·h of bivalirudin intravenously). The primary efficacy objective was to demonstrate superiority of PPA to reduce the primary efficacy end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The key secondary objective was to evaluate the effect of each specific anticoagulation regimen (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy end point. The primary safety end point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days.

RESULTS

Between January 10, 2019, and September 18, 2021, a total of 2989 patients were randomized. The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63 to 1.57]). The incidence of Bleeding Academic Research Consortium 3 to 5 bleeding did not differ between the PPA and placebo groups (8 [0.5%] vs 11 [0.7%] patients; hazard ratio, 0.74 [95% CI, 0.30 to 1.83]).

CONCLUSIONS

Routine PPA after primary percutaneous coronary intervention was safe but did not reduce 30-day ischemic events.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03664180.

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Affiliation(s)

Yan Yan Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.) Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.)
Jincheng Guo Beijing Luhe Hospital, Capital Medical University, Beijing, China (J.G., G.W.)
Xiao Wang Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.) Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.)
Guozhong Wang Beijing Luhe Hospital, Capital Medical University, Beijing, China (J.G., G.W.)
Zeyuan Fan Civil Aviation General Hospital, Beijing, China (Z.F.)
Delu Yin The First People's Hospital of Lianyungang, Jiangsu, China (D.Y.)
Zhifang Wang Xinxiang Central Hospital, Henan, China (Z.W.)
Fuchun Zhang Beijing Haidian Hospital, Beijing, China (F.Z.)
Changming Tian The People's Hospital of Yongcheng, Henan, China (C.T.)
Wei Gong Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.) Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.)
Jiamin Liu NHC Key Laboratory of Clinical Research for Cardiovascular Medications (J. Liu)
Jiapeng Lu National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China (J. Lu)
Yongjun Li The Second Hospital of Hebei Medical University, Shijiazhuang, China (Y.L.)
Changsheng Ma Arrhythmia Center (C.M.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.) Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.)
Eric Vicaut ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France (E.V.)
Gilles Montalescot Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.M.)
Shaoping Nie Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.) Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.)

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Li Y, Li Y, Qiu M, Xue Y, Xu K, Han Y. Ticagrelor vs clopidogrel when coadministered with bivalirudin in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Res Pract Thromb Haemost 2024;8:102375. [PMID: 38623472 PMCID: PMC11017352 DOI: 10.1016/j.rpth.2024.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/11/2023] [Accepted: 01/05/2024] [Indexed: 04/17/2024] Open

Benenati S, De Maria GL, Della Mora F, Portolan L, Kotronias R, Kharbanda RK, Porto I, Banning AP. Periprocedural antithrombotic strategies in acute coronary syndromes undergoing percutaneous coronary intervention: Have we discarded bivalirudin too soon? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023;57:70-79. [PMID: 37349187 DOI: 10.1016/j.carrev.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]

Abstract

BACKGROUND

Publication of the BRIGHT-4 trial results has restimulated discussion about the optimal periprocedural antithrombotic strategy for patients undergoing percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS). It is possible that variation in the infusion duration, may contribute to observed differences in safety-efficacy profiles of bivalirudin in this clinical setting.

METHODS

Up to December 2022, randomized controlled trials (RCTs) comparing bivalirudin (either administered peri-procedurally or accompanied by postprocedural infusion) and heparin, both with or without GPI, were searched and entered in a frequentist network meta-analysis. Co-primary endpoints were trial-defined major adverse composite events (MACE) and major bleeding. Incident rate ratios (IRR) and 95 % confidence intervals (CI) were estimated.

RESULTS

10 RCTs (N = 57,137 patients/month) were included. As compared to heparin, prolonged bivalirudin infusion resulted in lower rates of major bleeding (IRR 0.58, 95 % CI 0.36-0.91), but there was no differences in MACE rates between these strategies. With regard to NACE, prolonged bivalirudin infusion yielded lower risk (IRR 0.86, 95 % CI 0.77-0.96), whereas both bivalirudin and heparin increased risk when coupled with GPI (IRR 1.24, 95 % CI 1.01-1.51 and IRR 1.24, 95 % CI 1.06-1.44, respectively). Both these combination strategies also increased minor bleeding rates (IRR 1.49, 95 % CI 1.16-1.93 and IRR 1.58, 95 % CI 1.29-1.95, respectively, for bivalirudin and heparin). Results were consistent across several sensitivity analyses.

CONCLUSION

In patients with ACS undergoing PCI, procedural bivalirudin administration followed by prolonged infusion results in lower major bleeding rates, but there does not appear to be a difference in observed MACE.

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Galli M, Gargiulo G, Benenati S, Mehran R, Angiolillo DJ. Bivalirudin plus a high-dose infusion versus heparin in patients with acute coronary syndrome. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023;9:666-668. [PMID: 37081774 DOI: 10.1093/ehjcvp/pvad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]

Galli M, Bernardi M, Ortega-Paz L, Nerla R, D'Amario D, Franchi F, Biondi-Zoccai G, Angiolillo DJ. Bivalirudin in acute coronary syndromes. Expert Rev Cardiovasc Ther 2023;21:901-911. [PMID: 37919937 DOI: 10.1080/14779072.2023.2273902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]

Huang HT, Lv WQ, Xu FY, Wang XL, Yao YL, Su LJ, Zhao HJ, Huang Y. Mechanism of Yiqi Huoxue Huatan recipe in the treatment of coronary atherosclerotic disease through network pharmacology and experiments. Medicine (Baltimore) 2023;102:e34178. [PMID: 37390239 PMCID: PMC10313272 DOI: 10.1097/md.0000000000034178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open

Abstract

In recent years, with population aging and economic development, morbidity and mortality of atherosclerotic cardiovascular disease associated with atherosclerosis (AS) have gradually increased. In this study, a combination of network pharmacology and experimental verification was used to systematically explore the action mechanism of Yiqi Huoxue Huatan Recipe (YHHR) in the treatment of coronary atherosclerotic heart disease (CAD). We searched and screened the active ingredients of Coptis chinensis, Astragalus membranaceus, Salvia miltiorrhiza, and Hirudo. We also searched multiple databases for related target genes corresponding to the compounds and CAD. STRING was used to construct the protein-protein interaction (PPI) network of genes. Metascape was used to perform gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis for common targets to analyze the main pathways, and finally, the molecular docking and main possible pathways were verified by experimental studies. Firstly, a total of 1480 predicted target points were obtained through the Swiss Target Prediction database. After screening, merging, and deleting duplicate values, a total of 768 targets were obtained. Secondly, "Coronary atherosclerotic heart disease" was searched in databases such as the OMIM, GeneCards, and TTD. 1844 disease-related targets were obtained. Among PPI network diagram of YHHR-CAD, SRC had the highest degree value, followed by AKT1, TP53, hsp90aa1 and mapk3. The KEGG pathway bubble diagram was drawn using Chiplot, the Signal pathways such as NF kappa B signaling pathway, Lipid and AS, and Apelin signaling pathway are closely related to the occurrence of CAD. The PCR and Western blot methods were used to detect the expression of NF-κB p65. When compared with that in the model group, the expression of NF-κB p65mRNA decreased in the low-concentration YHHR group, with P < .05, while the expression of NF-κB p65mRNA decreased significantly in the high-concentration YHHR group, with P < .01. On the other hand, when compared with that in the model group, the expression of NF-κB p65 decreased in the low-concentration YHHR group, but was not statistically significant, while the expression of NF-κB p65 was significant in the high-concentration YHHR group, and has statistical significance with P < .05. YHHR has been shown to resist inflammation and AS through the SRC/NF-κB signaling pathway.

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Wu Z, Meng P, Guo Y, You W, Wu X, Ye F. Prolonged infusion of bivalirudin after elective percutaneous coronary intervention protects against procedural myocardial injury (a COBER study)-a randomized trial. Sci Rep 2023;13:6667. [PMID: 37095298 PMCID: PMC10126106 DOI: 10.1038/s41598-023-34008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/22/2023] [Indexed: 04/26/2023] Open

Abstract

Procedural myocardial injury (PMI), which is the most common complication of elective percutaneous coronary intervention (ePCI), is associated with future adverse cardiac events. In this randomized pilot trial, we assessed the effects of prolonged use of the anti-coagulant bivalirudin on PMI after ePCI. Patients undergoing ePCI were randomized into the following two groups: the bivalirudin use during operation group (BUDO, 0.75 mg/kg bolus plus 1.75 mg/kg/h) and the bivalirudin use during and after operation for 4 h (BUDAO, 0.75 mg/kg bolus plus 1.75 mg/kg/h). Blood samples were collected before and 24 h after ePCI (per 8 h). The primary outcome, PMI, was defined as an increase in post-ePCI cardiac troponin I (cTnI) levels of > 1 × 99th% upper reference limit (URL) when the pre-PCI cTnI was normal or a rise in cTnI of > 20% of the baseline value when it was above the 99th percentile URL, but it was stable or falling. Major PMI (MPMI) was defined as a post-ePCI cTnI increase of > 5 × 99th% URL. A total of 330 patients were included (n = 165 per group). The incidences of PMI and MPMI were not significantly higher in the BUDO group than in the BUDAO group (PMI: 115 [69.70%] vs. 102 [61.82%], P = 0.164; MPMI: 81 [49.09%] vs. 70 [42.42%], P = 0.269). However, the absolute change in cTnI levels (calculated as the peak value 24 h post-PCI minus the pre-PCI value) was notably larger in the BUDO group (0.13 [0.03, 1.95]) than in the BUDAO group (0.07 [0.01, 0.61]) (P = 0.045). Moreover, the incidence of bleeding events was similar between the two groups (BUDO: 0 [0.00%]; BUDAO: 2 [1.21%], P = 0.498). Prolonged infusion of bivalirudin for 4 h after ePCI reduces PMI severity without increasing the risk of bleeding.ClinicalTrials.gov.Number: NCT04120961, 09/10/2019.

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Vergallo R, Patrono C. A BRIGHT outlook for bivalirudin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2023;44:549-550. [PMID: 36478196 DOI: 10.1093/eurheartj/ehac732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

Li J, Chen S, Ma S, Yang M, Qi Z, Na K, Qiu M, Li Y, Han Y. Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study. Cardiovasc Ther 2022;2022:5352087. [PMID: 36530956 PMCID: PMC9729030 DOI: 10.1155/2022/5352087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 10/24/2023] Open

Coughlan JJ, Kastrati A. Bivalirudin in patients with ST-segment elevation myocardial infarction. Lancet 2022;400:1822-1823. [PMID: 36351460 DOI: 10.1016/s0140-6736(22)02162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]

Li Y, Liang Z, Qin L, Wang M, Wang X, Zhang H, Liu Y, Li Y, Jia Z, Liu L, Zhang H, Luo J, Dong S, Guo J, Zhu H, Li S, Zheng H, Liu L, Wu Y, Zhong Y, Qiu M, Han Y, Stone GW. Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial. Lancet 2022;400:1847-1857. [PMID: 36351459 DOI: 10.1016/s0140-6736(22)01999-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]

Abstract

BACKGROUND

Previous randomised trials of bivalirudin versus heparin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have reported conflicting results, in part because of treatment with different pharmacological regimens. We designed a large-scale trial examining bivalirudin with a post-PCI high-dose infusion compared with heparin alone, the regimens that previous studies have shown to have the best balance of safety and efficacy.

METHODS

BRIGHT-4 was an investigator-initiated, open-label, randomised controlled trial conducted at 87 clinical centres in 63 cities in China. Patients with STEMI undergoing primary PCI with radial artery access within 48 h of symptom onset who had not received previous fibrinolytic therapy, anticoagulants, or glycoprotein IIb/IIIa inhibitors were randomly assigned (1:1) to receive bivalirudin with a post-PCI high-dose infusion for 2-4 h or unfractionated heparin monotherapy. There was no masking. Glycoprotein IIb/IIIa inhibitor use was reserved for procedural thrombotic complications in both groups. The primary endpoint was a composite of all-cause mortality or Bleeding Academic Research Consortium (BARC) types 3-5 bleeding at 30 days. This trial is registered with ClinicalTrials.gov (NCT03822975), and is ongoing.

FINDINGS

Between Feb 14, 2019, and April 7, 2022, a total of 6016 patients with STEMI undergoing primary PCI were randomly assigned to receive either bivalirudin plus a high-dose infusion after PCI (n=3009) or unfractionated heparin monotherapy (n=3007). Radial artery access was used in 5593 (93·1%) of 6008 patients. Compared with heparin monotherapy, bivalirudin reduced the 30-day rate of the primary endpoint (132 events [4·39%] in the heparin group vs 92 events [3·06%] in the bivalirudin group; difference, 1·33%, 95% CI 0·38-2·29%; hazard ratio [HR] 0·69, 95% CI 0·53-0·91; p=0·0070). All-cause mortality within 30 days occurred in 118 (3·92%) heparin-assigned patients and in 89 (2·96%) bivalirudin-assigned patients (HR 0·75; 95% CI 0·57-0·99; p=0·0420), and BARC types 3-5 bleeding occurred in 24 (0·80%) heparin-assigned patients and five (0·17%) bivalirudin-assigned patients (HR 0·21; 95% CI 0·08-0·54; p=0·0014). There were no significant differences in the 30-day rates of reinfarction, stroke, or ischaemia-driven target vessel revascularisation between the groups. Within 30 days, stent thrombosis occurred in 11 (0·37%) of bivalirudin-assigned patients and 33 (1·10%) of heparin-assigned patients (p=0·0015).

INTERPRETATION

In patients with STEMI undergoing primary PCI predominantly with radial artery access, anticoagulation with bivalirudin plus a post-PCI high-dose infusion for 2-4 h significantly reduced the 30-day composite rate of all-cause mortality or BARC types 3-5 major bleeding compared with heparin monotherapy.

FUNDING

Chinese Society of Cardiology Foundation (CSCF2019A01), and a research grant from Jiangsu Hengrui Pharmaceuticals.

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Gragnano F, Calabrò P. Anticoagulation After Primary PCI: The Land of Promises and Uncertainty. JACC Cardiovasc Interv 2022;15:264-267. [PMID: 35144782 DOI: 10.1016/j.jcin.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 01/08/2023]

Yan Y, Gong W, Ma C, Wang X, Smith SC, Fonarow GC, Morgan L, Liu J, Vicaut E, Zhao D, Montalescot G, Nie S. Postprocedure Anticoagulation in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022;15:251-263. [PMID: 35144781 DOI: 10.1016/j.jcin.2021.11.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 01/01/2023]

Affiliation(s)

Yan Yan Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Wei Gong Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Changsheng Ma Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Xiao Wang Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Sidney C Smith Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
Gregg C Fonarow Division of Cardiology, Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA
Louise Morgan International Quality Improvement Department, American Heart Association, Dallas, Texas, USA
Jing Liu Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
Eric Vicaut ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France
Dong Zhao Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
Gilles Montalescot Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Shaoping Nie Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

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Faour A, Collins N, Williams T, Khan A, Juergens CP, Lo S, Walters DL, Chew DP, French JK. Reperfusion After Fibrinolytic Therapy (RAFT): An open-label, multi-centre, randomised controlled trial of bivalirudin versus heparin in rescue percutaneous coronary intervention. PLoS One 2021;16:e0259148. [PMID: 34699549 PMCID: PMC8547635 DOI: 10.1371/journal.pone.0259148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open

Abstract

BACKGROUND

The safety and efficacy profile of bivalirudin has not been examined in a randomised controlled trial of patients undergoing rescue PCI.

OBJECTIVES

We conducted an open-label, multi-centre, randomised controlled trial to compare bivalirudin with heparin ± glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing rescue PCI.

METHODS

Between 2010-2015, we randomly assigned 83 patients undergoing rescue PCI to bivalirudin (n = 42) or heparin ± GPIs (n = 41). The primary safety endpoint was any ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding at 90 days. The primary efficacy endpoint was infarct size measured by peak troponin levels as a multiple of the local upper reference limit (Tn/URL). Secondary endpoints included periprocedural change in haemoglobin adjusted for red cells transfused, TIMI (Thrombolysis in Myocardial Infarction) bleeding, ST-segment recovery and infarct size determined by the Selvester QRS score.

RESULTS

The trial was terminated due to slow recruitment and futility after an interim analysis of 83 patients. The primary safety endpoint occurred in 6 (14%) patients in the bivalirudin group (4.8% GPIs) and 3 (7.3%) in the heparin ± GPIs group (54% GPIs) (risk ratio, 1.95, 95% confidence interval [CI], 0.52-7.3, P = 0.48). Infarct size was similar between the two groups (mean Tn/URL, 730 [±675] for bivalirudin, versus 984 [±1585] for heparin ± GPIs, difference, 254, 95% CI, -283-794, P = 0.86). There was a smaller decrease in the periprocedural haemoglobin level with bivalirudin than heparin ± GPIs (-7.5% [±15] versus -14% [±17], difference, -6.5%, 95% CI, -0.83-14, P = 0.0067). The rate of complete (≥70%) ST-segment recovery post-PCI was higher in patients randomised to heparin ± GPIs compared with bivalirudin.

CONCLUSIONS

Whether bivalirudin compared with heparin ± GPI reduces bleeding in rescue PCI could not be determined. Slow recruitment and futility in the context of lower-than-expected bleeding event rates led to the termination of this trial (ANZCTR.org.au, ACTRN12610000152022).

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Voll F, Kuna C, Ndrepepa G, Kastrati A, Cassese S. Antithrombotic treatment in primary percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2021;19:313-324. [PMID: 33705211 DOI: 10.1080/14779072.2021.1902807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

Song CG, Bi LJ, Zhao JJ, Wang X, Li W, Yang F, Jiang W. The efficacy and safety of Hirudin plus Aspirin versus Warfarin in the secondary prevention of Cardioembolic Stroke due to Nonvalvular Atrial Fibrillation: A multicenter prospective cohort study. Int J Med Sci 2021;18:1167-1178. [PMID: 33526977 PMCID: PMC7847633 DOI: 10.7150/ijms.52752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 11/05/2022] Open

Abstract

Background: To investigate the efficacy and safety of hirudin plus aspirin therapy compared with warfarin in the secondary prevention of cardioembolic stroke due to nonvalvular atrial fibrillation (NVAF). Methods: Patients with cardioembolic stroke due to NVAF were prospectively enrolled from 18 collaborating hospitals from Dec 2011 to June 2015. Fourteen days after stroke onset, eligible patients were assigned to the hirudin plus aspirin group (natural hirudin prescribed as the traditional Chinese medicine Maixuekang capsule, 0.75 g, three times daily, combined with aspirin 100 mg, once daily) or the warfarin group (dose-adjusted warfarin targeting international normalized ratio (INR) 2-3, with an initial daily dose of 1.25 mg). Patients were followed up at 1, 2, 3, 6, 9, and 12 months after stroke onset. Time in therapeutic range (TTR) was calculated according to Rosendaal methodology to evaluate the quality of INR management in the warfarin group. The primary efficacy endpoint was the recurrence of stroke within 12 months after stroke onset. Safety was assessed as the occurrence of the composite event "intracranial hemorrhage and other bleeding events, death, and other serious adverse events". The Cox proportional hazard model and Kaplan-Meier curve were used to analyze the efficacy and safety events. Results: A total of 221 patients entered final analysis with 112 patients in the hirudin plus aspirin group and 109 in the warfarin group. Over the whole duration of our study, TTR for patients taking warfarin was 66.5 % ± 21.5%. A significant difference was not observed in the recurrence of stroke between the two groups (3.57% vs. 2.75%; P = 0.728). The occurrence of safety events was significantly lower in the hirudin plus aspirin group (2.68% vs.10.09%; P = 0.024). The risk for efficacy event was similar between the two groups (hazard ratio (HR), 1.30; 95% confidence interval (CI), 0.29-5.80). The safety risk was significantly lower in the hirudin plus aspirin group (HR, 0.27; 95% CI, 0.07-0.95). Kaplan-Meier analysis revealed significant difference in the temporal distribution in safety events (P = 0.023) but not in stroke recurrence (P = 0.726). Conclusion: Significant difference in efficacy was not detected between warfarin group and hirudin plus aspirin group. Compared with warfarin, hirudin plus aspirin therapy had lower safety risk in the secondary prevention of cardioembolic stroke due to NVAF.

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Yan Y, Wang X, Guo J, Li Y, Ai H, Gong W, Que B, Zhen L, Lu J, Ma C, Montalescot G, Nie S. Rationale and design of the RIGHT trial: A multicenter, randomized, double-blind, placebo-controlled trial of anticoagulation prolongation versus no anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am Heart J 2020;227:19-30. [PMID: 32663660 DOI: 10.1016/j.ahj.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]

Chang CC, Chichareon P, Modolo R, Takahashi K, Kogame N, Tomaniak M, Gao C, Royaards KJ, Cequier A, Oldroyd K, Steg PG, Hamm C, Jüni P, Valgimigli M, Windecker S, Onuma Y, Stables RH, Jan van Geuns R, Serruys PW. Association between post-percutaneous coronary intervention bivalirudin infusion and net adverse clinical events: a post hoc analysis of the GLOBAL LEADERS study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019;6:22-30. [DOI: 10.1093/ehjcvp/pvz051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/16/2019] [Accepted: 12/05/2019] [Indexed: 11/12/2022]

Abstract Abstract Aims The efficacy and safety of continued bivalirudin infusion after percutaneous coronary intervention (PCI) remains uncertain. We sought to investigate the association between post-PCI bivalirudin infusion and the risk of net adverse clinical events (NACE) at 30 days. Methods and results In the GLOBAL LEADERS study, all patients who received bivalirudin during PCI were categorized according to the use of bivalirudin infusion after the procedure. The primary endpoint of the present analysis was NACE [a composite of all-cause death, any stroke, any myocardial infarction, all revascularization, and bleeding assessed according to the Bleeding Academic Research Consortium (BARC) criteria Type 3 or 5] at 30 days. The key safety endpoint was BARC Type 3 or 5 bleeding and definite stent thrombosis. Of 15 968 patients, 13 870 underwent PCI with the use of bivalirudin. In total, 7148 patients received continued bivalirudin infusion after procedure, while 6722 patients received standard care. After propensity score covariate adjustment, the risk of NACE did not significantly differ between two treatments after PCI [continued bivalirudin infusion vs. no bivalirudin infusion: 3.2% vs. 3.1%, adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI) 0.99–1.84, P = 0.06] nor the BARC Type 3 or 5 bleeding (0.7% vs. 0.7%, aHR 0.89, 95% CI 0.44–1.79; P = 0.743) and definite stent thrombosis (0.5% vs. 0.3%, aHR 1.71, 95% CI 0.77–3.81, P = 0.189). However, continued bivalirudin infusion was associated with an increased risk of NACE and definite stent thrombosis in ST-elevation myocardial infarction (STEMI) patients. Conclusion In an all-comers population undergoing PCI, there was no significant difference in the risk of NACE at 30 days between continued bivalirudin infusion vs. no bivalirudin infusion after procedure but continued bivalirudin infusion was associated with a higher risk of NACE in STEMI patients when compared with no infusion. Collapse

Affiliation(s)

Chun Chin Chang Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, GD Rotterdam, Netherlands Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Beitou 11217, Taipei, Taiwan Institute of Clinical Medicine, National Yang Ming University, Beitou 11221, Taipei, Taiwan
Ply Chichareon Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
Rodrigo Modolo Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
Kuniaki Takahashi Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
Norihiro Kogame Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
Mariusz Tomaniak Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, GD Rotterdam, Netherlands
Chao Gao Cardiology Department, Radboudumc, Comeniuslaan 4 6525 HP, Nijmegen, the Netherlands
Kees-Jan Royaards Department of Cardiology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, Netherlands
Angel Cequier Department of Cardiology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
Keith Oldroyd West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
Philippe Gabriel Steg Cardiology Department, AP-HP, Hospital, Bichat, 75018 Paris, France
Christian Hamm Department of Cardiology, Kerckhoff Heart Center, 61231Bad Nauheim, Germany
Peter Jüni Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M4P 1A6, Canada
Marco Valgimigli Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
Stephan Windecker Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
Yoshinobu Onuma Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, GD Rotterdam, Netherlands Cardialysis B.V., 3012 KM Rotterdam, Netherlands
Rod H Stables Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK
Robert Jan van Geuns Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, GD Rotterdam, Netherlands Cardiology Department, Radboudumc, Comeniuslaan 4 6525 HP, Nijmegen, the Netherlands
Patrick W Serruys National Heart and Lung Institute, Imperial College London, London, UK

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Chen W, Lu D, Huang Z, Xiao L. Is a prolongation of bivalirudin infusion needed in patients with STEMI undergoing percutaneous coronary intervention? Catheter Cardiovasc Interv 2019;94:898-899. [PMID: 31183989 DOI: 10.1002/ccd.28368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022]

ECG analysis in patients with acute coronary syndrome undergoing invasive management: rationale and design of the electrocardiography sub-study of the MATRIX trial. J Electrocardiol 2019;57:44-54. [PMID: 31491602 DOI: 10.1016/j.jelectrocard.2019.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/18/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]

Li W, Mai L, Cai X, Li M, Huang Y. Bivalirudin infusion in patients with acute coronary syndrome after stenting. Expert Opin Pharmacother 2019;20:1413-1414. [PMID: 31056962 DOI: 10.1080/14656566.2019.1615329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]

Montalescot G, Angiolillo DJ. Anticoagulation, the Unknown of the Antithrombotic Equation After Stenting of an Acute Coronary Syndrome. J Am Coll Cardiol 2019;73:775-778. [DOI: 10.1016/j.jacc.2018.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]