Bivalirudin versus Heparin Monotherapy in Myocardial Infarction

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Bivalirudin versus Heparin Monotherapy in Myocardial Infarction

Erlinge, D. (author): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Molecular Cardiology,Lund University Research Groups,Lund University, Sweden

Omerovic, Elmir (author): Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.

Fröbert, Ole, 1964- (author): Örebro University,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden,Rebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden.

Linder, Rikard (author): Karolinska Institutet,Danderyd Hospital, Sweden

Danielewicz, Mikael (author): PCI-Unit at Karlstad Hospital, Karlstad, Sweden,Karlstad Hosp, PCI Unit, Karlstad, Sweden.

Hamid, Mehmet (author): Department of Cardiology, Mälarsjukhuset, Eskilstuna, Sweden,Malarsjukhuset, Dept Cardiol, Eskilstuna, Sweden.

Swahn, Eva (author): Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US

Henareh, Loghman (author): Karolinska Institutet,Karolinska University Hospital, Sweden

Wagner, H. (author): Department of Cardiology, Helsingborg Lasarett, Helsingborg, Sweden,Helsingborg Lasarett, Dept Cardiol, Helsingborg, Sweden.,Helsingborg Hospital

Hårdhammar, Peter (author): Department of Cardiology, Halmstad Hospital, Halmstad, Sweden,Halmstad Cty Hosp, Dept Cardiol, Halmstad, Sweden.,Halmstad County Hospital, Sweden

Sjögren, Iwar (author): Department of Cardiology, Falun Hospital, Falun, Sweden,Falun Cent Hosp, Dept Cardiol, Falun, Sweden.,Falun Central Hospital, Sweden

Stewart, Jason (author): Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden,Skaraborgs Hosp, Dept Cardiol, Skovde, Sweden.

Grimfjärd, Per (author): Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden,Vastmanlands Sjukhus, Dept Internal Med, Vasteras, Sweden.,Västmanland Hospital

Jensen, Jens (author): Umeå University,Karolinska Institute,Karolinska Institutet,Karolinska Institute, Sweden,Sunderby Sjukhus, Sweden,Umeå University, Sweden

Aasa, Mikael (author): Department of Cardiology, Södersjukhuset AB, Stockholm, Sweden,Sodersjukhuset AB, Dept Cardiol, Stockholm, Sweden.,Stockholm South General Hospital

Robertsson, Lotta (author): Department of Internal Medicine, Västmanlands Sjukhus, Västerås, Sweden,Sodra Alvsborgs Sjukhus, Dept Cardiol, Boras, Sweden.,South Elfsborg Hospital

Lindroos, Pontus (author): Department of Cardiology, Capio St. Görans Hospital, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Capio St Gorans Hosp, Dept Cardiol, Stockholm, Sweden.,Capio St. Görans Sjukhus

Haupt, Jan (author): Department of Cardiology, Sunderby Sjukhus, Luleå, Sweden,Sunderby Hospital

Wikström, Helena (author): Department of Cardiology, Kristianstad Hospital, Kristianstad, Sweden,Kristianstad Hosp, Dept Cardiol, Kristianstad, Sweden.,Central Hospital Kristianstad

Ulvenstam, Anders (author): Umeå universitet,Avdelningen för medicin,Ostersund Hosp, Dept Cardiol, Ostersund, Sweden.,Östersund Hospital, Sweden

Bhiladvala, P. (author): Lund University,Lunds universitet,Kardiologiska klinikens forskargrupp,Forskargrupper vid Lunds universitet,Cardiology Research Group,Lund University Research Groups,Lund University, Sweden

Lindvall, Bo (author): Department of Cardiology, Sundsvall Hospital, Sundsvall, Sweden,Sundsvall Hosp, Dept Cardiol, Sundsvall, Sweden.

Lundin, Anders (author): Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden,Lund Univ, Dept Cardiol Clin Sci, Lund, Sweden.

Tödt, T. (author): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University, Sweden,Sahlgrens University Hospital, Sweden,Örebro University, Sweden

Ioanes, Dan (author): Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.

Råmunddal, Truls (author): Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden

Kellerth, Thomas (author): Örebro University

Zagozdzon, Leszek (author): Örebro University,Örebro University, Sweden

Götberg, M. (author): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University, Sweden

Andersson, Jonas (author): Umeå universitet,Kardiologi

Angerås, Oskar (author): Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden,Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.

Östlund, Ollie (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Uppsala University, Sweden

Lagerqvist, Bo, 1952- (author): Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University Hospital,Uppsala University, Sweden

Held, Claes, 1956- (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala University Hospital,Uppsala University, Sweden

Wallentin, Lars, 1943- (author): Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University Hospital,Uppsala University, Sweden

Scherstén, F. (author): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University, Sweden

Eriksson, Peter (author): Umeå University,Umeå universitet,Kardiologi,Umea Univ, Dept Cardiol, Umea, Sweden.,Umeå University, Sweden

Koul, S. (author): Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Molecular Cardiology,Lund University Research Groups,Lund University, Sweden

James, Stefan, 1964- (author): Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University Hospital,Uppsala University, Sweden

Linder, Robert, 1981- (author): Umeå universitet,Lungmedicin

Abdel-Hamid, Mohamed (author): Mälar Hospital

Östlund, Olof (author): Uppsala University Hospital

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Massachusetts Medical Society, 2017
2017
English.
In: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 377:12, s. 1132-1142

Related links:: http://dx.doi.org/10...; show more...; https://liu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; https://urn.kb.se/re...; https://urn.kb.se/re...; http://kipublication...; https://lup.lub.lu.s...; https://urn.kb.se/re...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. Methods In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. Results A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Conclusions Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .).

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

Articles in the publication: New England Jour ...

By the university: Örebro University; Umeå University; Uppsala University; Karolinska Institutet; Lund University; Linköping University

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Bivalirudin versus Heparin Monotherapy in Myocardial Infarction

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