Bleeding Risk Comparing Targeted Low-Dose Heparin With Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention

Abstract In patients undergoing percutaneous coronary intervention, catheter thrombosis is more frequent with fondaparinux than heparin. This study was undertaken to identify the responsible mechanism and to develop strategies for its prevention. Percutaneous coronary intervention catheter segments shortened plasma clotting times from 971 ± 92 to 352 ± 22 seconds. This activity is factor XII (fXII) dependent because it was attenuated with corn trypsin inhibitor and was abolished in fXII-deficient plasma. Heparin and enoxaparin blocked catheter-induced clotting at 0.5 and 2 anti-Xa U/mL, respectively, whereas fondaparinux had no effect. Addition of fondaparinux to bivalirudin or low-dose heparin attenuated catheter-induced clotting more than either agent alone. In a rabbit model of catheter thrombosis, a 70 anti-Xa U/kg intravenous bolus of heparin or enoxaparin prolonged the time to catheter occlusion by 4.6- and 2.5-fold, respectively, compared with saline, whereas the same dose of fondaparinux had no effect. Although 15 anti-Xa U/kg heparin had no effect on its own, when given in conjunction with 70 anti-Xa U/kg fondaparinux, the time to catheter occlusion was prolonged 2.9-fold. These findings indicate that (1) catheters are prothrombotic because they trigger fXII activation, and (2) fondaparinux does not prevent catheter-induced clotting unless supplemented with low-dose heparin or bivalirudin.

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Low-Dose Heparin for Elective Percutaneous Coronary Intervention

Journal of Interventional Cardiology ◽

10.1111/joic.12081 ◽

2013 ◽

Vol 27 (1) ◽

pp. 58-62 ◽

Cited By ~ 5

Author(s):

MICHAEL S. LEE ◽

JARED OYAMA ◽

ZAHID IQBAL ◽

GIUSEPPE TARANTINI

Keyword(s):

Percutaneous Coronary Intervention ◽

Low Dose ◽

Coronary Intervention ◽

Elective Percutaneous Coronary Intervention ◽

Dose Heparin ◽

Percutaneous Coronary ◽

Low Dose Heparin

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P3694Multicenter research of bleeding risk between low dose prasugrel and standard dose clopidogrel in patients with coronary artery disease undergoing percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehx504.p3694 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

S. Tokimasa ◽

H. Kitahara ◽

T. Nakayama ◽

Y. Fujimoto ◽

T. Shiba ◽

...

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Low Dose ◽

Standard Dose ◽

Bleeding Risk ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Artery Disease

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Abstract 14931: Low-Dose Prasugrel Has Prognostic Superiority to Clopidogrel in High-Bleeding Risk Patients Undergoing Contemporary Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.142.suppl_3.14931 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takuro Abe ◽

Kentaro Jujo ◽

Takehiro Hata ◽

KAZUHO KAMISHIMA ◽

Hiroshi Koganei ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Major Bleeding ◽

Low Dose ◽

Bleeding Event ◽

Composite Endpoint ◽

Bleeding Risk ◽

Coronary Intervention ◽

Major Bleeding Event ◽

Percutaneous Coronary ◽

High Bleeding Risk

Introduction: The combination of aspirin and P2Y12 receptor antagonist is the standard antiplatelet therapy after percutaneous coronary intervention (PCI). Previous trials reported that prasugrel reduced the risk of ischemic events, but increased bleeding events compared to clopidogrel. Hypothesis: The prognostic impact of low-dose prasugrel (3.75 mg/day), which the dose was determined by phase II trial, is different from that of clopidogrel, depending on patient’s bleeding risk. Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI. We analyzed 1,001 patients who received the combination of aspirin and prasugrel or clopidogrel after PCI. The primary endpoint was a composite of major bleeding event and major adverse cardiovascular and cerebrovascular events (MACCE) including any death, acute coronary syndrome, stent thrombosis, stroke and heart failure hospitalization. Results: There were 490 patients with high bleeding risk (HBR) and 511 patients with low bleeding risk (LBR), based on ARC-HBR criteria. In HBR patients, the Low-dose prasugrel group had significantly lower rates of MACCE (Log-rank, p=0.003) and the composite endpoint than the Clopidogrel group (p=0.001). While, in LBR patients, there was no significant difference in rates of MACCE or the composite endpoint between the groups (p=0.76, p=0.15, respectively), and a higher rate of major bleeding event in the Low-dose prasugrel group (p=0.002). With Cox proportional hazards analysis, low-dose prasugrel has still retained the superiority to clopidogrel regarding with the composite endpoint in HBR patients, even after adjusting with diverse covariates (hazard ratio: 0.33, 95% confidence interval: 0.16-0.65). Conclusion: In the multicenter cohort study in Japan, low-dose prasugrel showed a long-term prognostic superiority to clopidogrel only in HBR patients undergoing contemporary PCI.

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