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Bivalirudin versus ...
Bivalirudin versus heparin with primary percutaneous coronary intervention
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- Venetsanos, Dimitrios (author)
- Linköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US,Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden
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- Sederholm Lawesson, Sofia, 1973- (author)
- Linköping University,Linköpings universitet,Medicinska fakulteten,Avdelningen för kardiovaskulär medicin,Region Östergötland, Kardiologiska kliniken US,Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden
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- James, Stefan K, 1964- (author)
- Uppsala University,Uppsala universitet,Kardiologi,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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- Koul, Sasha (author)
- Lund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups
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- Erlinge, David (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
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- Swahn, Eva (author)
- Linköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US,Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden
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- Alfredsson, Joakim (author)
- Linköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US,Linkoping Univ, Dept Cardiol, SE-58183 Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden
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(creator_code:org_t)
- Philadelphia, United States : Mosby, Inc. 2018
- 2018
- English.
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In: American Heart Journal. - Philadelphia, United States : Mosby, Inc.. - 0002-8703 .- 1097-6744. ; 201, s. 9-16
- Related links:
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http://dx.doi.org/10...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://lup.lub.lu.s...
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Abstract
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- Background: Optimal adjunctive therapy in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI (PPCI) remains a matter of debate. Our aim was to compare the efficacy and safety of bivalirudin to unfractionated heparin (UFH), with or without glycoprotein IIb/IIIa inhibitors (GPI) in a large real-world population, using data from the Swedish national registry, SWEDEHEART. Method: From 2008 to 2014 we identified 23,800 STEMI patients presenting within 12 hours from symptom onset treated with PPCI and UFH +/- GPI or bivalirudin +/- GPI. Primary outcomes included 30-day all-cause mortality and major in-hospital bleeding. Multivariable regression models and propensity score modelling were utilized to study adjusted association between treatment and outcome. Results: Treatment with UFH +/- GPI was associated with similar risk of 30-day mortality compared to bivalirudin +/- GPI (5.3% vs 5.5%, adjusted HR 0.94; 95% CI 0.82-1.07). The adjusted risk for 1-year mortality, 30-day and 1-year stent thrombosis and re-infarction did not differ significantly between UFH +/- GPI and bivalirudin +/- GPI. In contrast, treatment with UFH +/- GPI was associated with a significant higher risk of major in-hospital bleeding (adjusted OR 1.62; 95% CI 1.30-2.03). When including GPI use in the multivariable analysis, the difference was attenuated and no longer significant (adjusted OR 1.25; 95% CI 0.92-1.70). Conclusion: Bivalirudin +/- GPI was associated with significantly lower risk for major in hospital bleeding but no significant difference in 30-day or one year mortality, stent thrombosis or re-infarction compared with UFH +/- GPI. The bleeding reduction associated with bivalirudin could be explained by the greater GPI use with UFH. (C) 2018 Elsevier Inc. All rights reserved.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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