The role of bivalirudin in percutaneous coronary intervention

2010 ◽  
pp. 440-456
Author(s):  
Steffen Massberg ◽  
Julinda Mehilli ◽  
Adnan Kastrati
Keyword(s):  
Fatal Outcome ◽  
Anticoagulation Therapy ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Cardiovascular Research ◽  
Percutaneous Coronary ◽  
Thrombotic Complications ◽  
Artery Disease

Rapid progress has been made in interventional cardiology over the past years, and many patients with coronary artery disease, even those with complex lesions, are nowadays being treated with percutaneous coronary interventions (PCI). As a result, a major focus of current cardiovascular research is on reducing negative peri-procedural clinical events associated with PCI, particularly in high-risk patients. Among the most dangerous peri-procedural events are thrombotic complications, leading to recurrent myocardial or cerebral ischaemia, often with fatal outcome. Anticoagulant and antithrombotic treatment, therefore, is an integral part of current PCI strategies. It is needless to say that prevention of procedural thrombotic events with the use of anticoagulants occurs at the expense of severe bleeding complications. Hence, there has been a strong effort over recent years to develop and validate novel anticoagulant regimens that provide protection against thrombotic complications, but have only minor effects on normal haemostasis. Until recently, the standard anticoagulation therapy during PCI consisted in either unfractionated (UFH) or low-molecular-weight heparin (LMWH) that prevent coagulation indirectly by activation of antithrombin (AT). Once activated, AT inactivates thrombin and other proteases involved in blood clotting. However, only recently direct thrombin inhibitors (DTI) have been introduced as an alternative anticoagulant strategy in patients undergoing PCI. Bivalirudin is the most prominent member of the DTI class, directly inhibiting free- and clot-bound thrombin. Use of bivalirudin has recently been shown to result in a significant reduction of bleeding without an increase in thrombotic or ischaemic endpoints compared to heparin and glycoprotein (GP) IIb/IIIa inhibitors in patients presenting with acute coronary syndromes (ACS). This chapter will give an overview of the pharmacology and mechanism of action of bivalirudin and summarize results from recent clinical trials evaluating the use of bivalirudin in patients undergoing PCI.

The role of bivalirudin in percutaneous coronary intervention

2018 ◽  
pp. 401-417
Author(s):  
Stefanie Schüpke ◽  
Steffen Massberg ◽  
Adnan Kastrati
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Fatal Outcome ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Cardiovascular Research ◽  
Percutaneous Coronary ◽  
Thrombotic Complications ◽  
Artery Disease

Rapid progress has been made in interventional cardiology over the past years; many patients with coronary artery disease, even those with complex lesions, are nowadays being treated with percutaneous coronary intervention (PCI). As a result, a major focus of current cardiovascular research is on reducing negative periprocedural clinical events associated with PCI, particularly in high-risk patients. Among the most dangerous periprocedural events are thrombotic complications, leading to recurrent myocardial or cerebral ischaemia, often with fatal outcome. Anticoagulant and antiplatelet treatment, therefore, is an integral part of current PCI strategies. However, prevention of procedural thrombotic events with the use of anticoagulants occurs at the expense of severe bleeding complications. Hence, there has been a strong effort over the last few years to develop and validate novel anticoagulant regimens that provide protection against thrombotic complications, but have only minor effects on normal haemostasis. Parts of these efforts has also been the development of bivalirudin.

Oxford Textbook of Interventional Cardiology

2018 ◽  
Keyword(s):  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Western Society ◽  
Evidence Based ◽  
New Techniques ◽  
Novel Section ◽  
Percutaneous Coronary ◽  
Expert Team ◽  
Artery Disease ◽  
Evidence Based Guidelines

The Oxford Textbook of Interventional Cardiology is the definitive text, spanning the whole spectrum of interventional cardiology procedures, including management of patients with coronary artery disease, one of the leading killers in western society. This textbook, covering key procedures and fully revised and updated to include the latest trials, technology, and new techniques, is essential reading. The Oxford Textbook of Interventional Cardiology 2nd edition spans the whole spectrum of interventional cardiology procedures, including a novel section on the future of interventional cardiology, and multiple new chapters covering special devices in percutaneous coronary intervention. Written by an expert team of international authors, this book offers guidance on all aspects of interventional cardiology according to the European curriculum, and covers the evidence-based guidelines for a comprehensive view of the field.

Bleeding and haemostasis disorders

2021 ◽  
pp. 926-937
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke).

scholarly journals Optimum Antithrombotic Therapy in Patients Requiring Long-Term Anticoagulation and Undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Nayan Agarwal ◽  
Dhruv Mahtta ◽  
Cecil A. Rambarat ◽  
Islam Elgendy ◽  
Ahmed N. Mahmoud
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Anticoagulation Therapy ◽  
Standard Of Care ◽  
Dual Therapy ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

Management of patients on long-term anticoagulation requiring percutaneous coronary intervention is challenging. Triple therapy with oral anticoagulant and dual antiplatelet therapy is the standard of care. However, there is no strong evidence to support this strategy. There is emerging data regarding the safety and efficacy of dual therapy with oral anticoagulant and single antiplatelet therapy in these patients. In this comprehensive review we highlight available evidence regarding various antithrombotic regimens’ efficacy and safety in patient with coronary artery disease undergoing percutaneous coronary intervention with long-term anticoagulation therapy requirements.

scholarly journals COMPARATIVE EVALUATION OF EFFICACY AND SAFETY OF ASPIRIN + CLOPIDOGREL WITH ASPIRIN+TICAGRELOR IN PATIENTS WITH CARDIOVASCULAR DISEASES. AN OBSERVATIONAL STUDY.

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Dr. Pinki Saini ◽  
Dr. Poonam Patel ◽  
Dr. Murtuza Bhora ◽  
Dr. S. Tripathi ◽  
Dr. P. Nyati
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Severe Bleeding ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Background: Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity in both developed and developing countries. It is a leading cause of death in India, and its contribution to mortality is rising. Platelets play an essential role in the pathogenesis of acute coronary syndromes (ACS). Therefore an important part of the treatment of ACS, and of primary and secondary preventive measures in coronary heart disease, consists of antiplatelet treatment. Dual antiplatelet therapy (DAPT) provides more intense platelet inhibition than single antiplatelet therapy resulting in incremental reductions in the risk of thrombotic events after percutaneous coronary intervention (PCI) or ACS, but it has been associated with an increased risk of major bleeding. It is interesting to consider that there is no Indian data on the efficacy of recently developed antiplatelet drugs other than in combination with aspirin, and that we remain unaware of the extent to which combinations with aspirin improve efficacy but increase risk. Methodology: Study was prospective, observational clinical study carried out in the Department of Medicine, of Index Medical College Hospital & Research Centre. A total of 80 patients with CAD were enrolled for the study and were equally divided in two groups each of 40 for evaluating efficacy and safety of dual antiplatelet therapy. Follow-up was done at 8 weeks, 16 weeks, and 24 weeks, patients were asked to provide information regarding their current medications, any morbidity and their complications [if any]. Demographic parameters were analyzed by descriptive statistics. Comparison between groups was done by Chi–square Test. Survival analysis was done by suitable statistical method. Result: The median age was 55 years in group 1 and 57 years in group 2. Hypertension was most common associated disorders in group 1 [25 (62.55%)] and group 2 [27 (67.5%)], which was followed by diabetes and dyslipidemia. index events for present study enrolment was unstable angina, non–ST-segment elevation MI, ST-segment elevation MI and others amongs the study groups. With 6 months of follow-up, the rate of the primary event like death from any cause was 7.5 percent in the clopidogrel plus aspirin group and 2.5 percent in the ticagrelor plus aspirin group. The primary safety end point (severe bleeding) was 2.5 %  in the clopidogrel plus group 1 and none in group 2. Conclusion: the combination of clopidogrel plus aspirin was found to be non inferior to aspirin plus ticagrelor dual therapy in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes among patients with stable cardiovascular disease or multiple cardiovascular risk factors. The risk of moderate to severe bleeding was increased slightly in both the groups. Our findings do support the use of dual antiplatelet therapy across the broad population tested where single antiplatelet therapy are not giving maximum benefits Keywords: Acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), Coronary artery disease (CAD), Dual antiplatelet therapy (DAPT)

Abstract 161: National Trends in Use of Radial Access for Percutaneous Coronary Intervention in China: 2001-2011

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Xin Zheng ◽  
Jeptha Curtis ◽  
Shuang Hu ◽  
Yuejin Yang ◽  
Frederick A Masoudi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Elderly Women ◽  
Multivariable Analysis ◽  
Sampling Strategy ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Radial Access ◽  
Percutaneous Coronary

Background: The use of radial access for percutaneous coronary intervention (r-PCI) is associated with reduced risk of bleeding complications and higher patient satisfaction. However, the use of r-PCI differs greatly by country and is unknown in China. We examined trends in the adoption of r-PCI in China over the past decade and identified factors associated with its use. Methods: We used a two-stage random sampling strategy to create a nationally representative sample of 5,462 patients undergoing percutaneous coronary intervention (PCI) in China in 2001 (n=402; 24 sites), 2006 (n=1,390; 44 sites), and 2011 (n=3,670; 54 sites). We calculated the weighted proportion of patients receiving r-PCI in each time period and conducted multivariable analysis to identify the patient and hospital characteristics associated with not receiving r-PCI in 2011. Results: Among 5,462 patients who underwent PCI, the use of r-PCI increased markedly over time (2001: 3.4% [95% CI 0.0%-8.5%]; 2006: 36.5% [95% CI 34.2%-38.9%], 2011: 74.7% [95% CI 73.9-75.6]; P for trend <0.001). Increases in r-PCI use were widespread, including high-risk subgroups such as the elderly, women, and patients with acute coronary syndromes (Figure). In multivariable analysis of 3,670 patients undergoing PCI in 2011, cardiogenic shock and emergency PCI were strongly associated with failure to use r-PCI in 2011. Conclusion: Over a recent ten-year period, radial access became the predominant strategy for PCI in China, even among high-risk patients. This study demonstrates the responsiveness of the interventional cardiology community to emerging evidence. A deeper understanding of the factors facilitating r-PCI adoption in China may help increase its usage in countries in which r-PCI use remains low.

Antithrombotic Strategies in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

2018 ◽  
Vol 24 (4) ◽  
pp. 496-510
Author(s):  
Daorong Pan ◽  
Xiaomin Ren ◽  
Zuoying Hu
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Antithrombotic Therapy ◽  
Clinical Decision Making ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Clinical Decision ◽  
Bleeding Complications ◽  
Percutaneous Coronary

The optimal strategy of antithrombotic therapy for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention remains to be a question to be answered. The major challenge in such population is the balance between the benefit of reduced stroke and coronary ischemic events, against the risk of increased bleeding complications. Thus, both thrombotic and bleeding risk assessments should be included into clinical decision-making process for such patients. Currently, there is limited evidence based on randomized trials with adequate power to show the superiority of any strategy in the beneficial profile of safety and efficacy, thus limited recommendations are provided by clinical guidelines. Given the recent advancement in this field, our review provided an overview of the available risk stratification schemes for stroke and bleeding risk for AF patients, discussed the multiple questions in the optimal regimens of oral antiplatelet and anticoagulation therapy, and summarized evidence and recommendations related to long-term antithrombotic therapy for AF patients receiving stent implications.

Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin

1999 ◽  
Vol 8 (5) ◽  
pp. 303-313 ◽  
Author(s):  
NB Juran ◽  
CL Rouse ◽  
DD Smith ◽  
MA O'Brien ◽  
SA DeLuca ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Standards Of Care ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Nursing Interventions ◽  
Access Site ◽  
Femoral Access ◽  
Percutaneous Coronary ◽  
Coronary Procedures

BACKGROUND: This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin. OBJECTIVE: To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications. METHODS: In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures. RESULTS: Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath. CONCLUSION: Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.

scholarly journals The role of mechanical support devices during percutaneous coronary intervention

2021 ◽  
Vol 10 ◽  
pp. 204800402110140
Author(s):  
Ritesh Kanyal ◽  
Jonathan Byrne
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
High Risk Patient ◽  
Haemodynamic Effect ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Percutaneous Coronary ◽  
Artery Disease

The practice of interventional cardiology has changed dramatically over the last four decades since Andreas Gruentzig carried out the first balloon angioplasty. The obvious technological improvements in stent design and interventional techniques have facilitated the routine treatment of a higher risk cohort of patients, including those with complex coronary artery disease and poor left ventricular function, and more often in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (AMI). The use of mechanical cardiac support (MCS) in these settings has been the subject of intense interest, particularly over the past decade . A number of commercially available devices now add to the interventional cardiologist’s armamentarium when faced with the critically unwell or high-risk patient in the cardiac catheter laboratory. The theoretical advantage of such devices in these settings is clear- an increase in cardiac output and hence mean arterial pressure, with variable effects on coronary blood flow. In doing so, they have the potential to prevent the downward cascade of ischaemia and hypoperfusion, but there is a paucity of evidence to support their routine use in any patient subset, even those presenting with cardiogenic shock. This review will discuss the use and haemodynamic effect of MCS devices during percutaneous coronary intervention (PCI), and also examine the clinical evidence for their use in patients with cardiogenic shock, and those undergoing ‘high risk’ PCI

Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey

2020 ◽  
Author(s):  
Davide Cao ◽  
Rishi Chandiramani ◽  
Mauro Chiarito ◽  
Bimmer E Claessen ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Antithrombotic Agents ◽  
Future Directions ◽  
Coronary Stent Implantation ◽  
Percutaneous Coronary ◽  
Therapeutic Procedures ◽  
Artery Disease

Abstract Since its introduction in 1977, percutaneous coronary intervention has become one of the most commonly performed therapeutic procedures worldwide. Such widespread diffusion, however, would have not been possible without a concomitant evolution of the pharmacotherapies associated with this intervention. Antithrombotic agents are fundamental throughout the management of patients undergoing coronary stent implantation, starting from the procedure itself to the long-term prevention of cardiovascular events. The last 40 years of interventional cardiology have seen remarkable improvements in both drug therapies and device technologies, which largely reflected a progressive understanding of the pathophysiological mechanisms of coronary artery disease, as well as procedure- and device-related adverse events. The purpose of this article is to provide an overview of the important milestones in antithrombotic pharmacology that have shaped clinical practice of today while also providing insights into knowledge gaps and future directions.

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