Intravenous Enoxaparin Versus Unfractionated Heparin in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention

Angiology ◽  
2016 ◽  
Vol 68 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Zhenyu Liu ◽  
Johanne Silvain ◽  
Mathieu Kerneis ◽  
Olivier Barthélémy ◽  
Laurent Payot ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Elderly Patients ◽  
Unfractionated Heparin ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
The Elderly ◽  
Minor Bleeding ◽  
End Point ◽  
Percutaneous Coronary

Elderly (≥75 years old) patients with ST-segment elevation myocardial infarction (STEMI) have higher ischemic and bleeding risk compared with those <75 years old. We investigated the efficacy and safety of intravenous (IV) enoxaparin versus IV unfractionated heparin (UFH) in elderly patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. A prespecified analysis of the Acute Myocardial Infarction Treated with Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short- and Long-term Follow-up (ATOLL) study was performed examining the 30-day outcomes in the elderly patients. Of the 165 elderly patients in the ATOLL study, 85 patients received IV enoxaparin 0.5 mg/kg and 80 patients received IV UFH. Intravenous enoxaparin did not reduce the primary end point, the main secondary efficacy end point, major bleeding, major or minor bleeding, and all-cause mortality compared with IV UFH. The rate of minor bleeding (5.9% vs 22.8%, Padjusted = .01) was significantly lower with IV enoxaparin compared with IV UFH. Intravenous enoxaparin appears to be a safe alternative to IV UFH in primary PCI of the elderly patients with STEMI.

scholarly journals Bivalirudin Versus Heparin Monotherapy in Elderly Patients With Myocardial Infarction

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Axel Wester ◽  
Rubina Attar ◽  
Moman A. Mohammad ◽  
Nazim Isma ◽  
Stefan James ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Coronary Intervention ◽  
The Elderly ◽  
End Point ◽  
St Segment ◽  
Increased Risk ◽  
Percutaneous Coronary

Background: Elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention are at increased risk of both ischemic and bleeding complications. The optimal anticoagulation strategy in these patients is uncertain. Therefore, we compared bivalirudin to heparin monotherapy in a contemporary cohort of such patients. Methods: A prespecified subgroup analysis of elderly patients with myocardial infarction (≥75 years) from the VALIDATE-SWEDEHEART trial (Bivalirudin Versus Heparin in ST-Segment and Non–ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) was performed. In the trial, patients were randomized to either bivalirudin or heparin monotherapy during percutaneous coronary intervention, with mandatory potent P2Y12 inhibition, routine radial artery access, and only bail-out glycoprotein IIb/IIIa inhibition. Kaplan-Meier event rates were assessed for the primary end point, consisting of a composite of all-cause death, myocardial reinfarction, or major bleeding, within 180 days. Results: The elderly (n=1592) had more than twice the risk of all events compared with younger patients (n=4406). Baseline and periprocedural characteristics were equal between bivalirudin (n=799) and heparin (n=793) treated patients ≥75 years. No differences were found in the elderly between bivalirudin and heparin monotherapy regarding the primary end point (180-day all-cause death, myocardial reinfarction, or major bleeding), the individual components of the primary end point, definite stent thrombosis, or stroke. Conclusions: In this prespecified subgroup analysis of the VALIDATE-SWEDEHEART trial, elderly patients with myocardial infarction had a highly increased risk of all events. However, no difference in outcomes could be observed with an anticoagulation strategy with either bivalirudin or heparin as monotherapy in this patient group.

Abstract 3342: Adequacy of Inclusion of Post-Procedural Bleeding in a Composite End Point for Assessment of Outcome After Percutaneous Coronary Intervention.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stefanie Schulz ◽  
Gjin Ndrepepa ◽  
Julinda Mehilli ◽  
Raisuke Iijima ◽  
Olga Bruskina ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Unfractionated Heparin ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
End Point ◽  
Prediction Of Mortality ◽  
Percutaneous Coronary ◽  
One Year

Objective: To assess the adequacy of inclusion of post-procedural bleeding in a quadruple composite end point for the prediction of mortality after percutaneous coronary intervention (PCI). Methods: This study included 5384 patients from 4 ISAR randomized trials on the value of abciximab: ISAR-REACT, ISAR-SWEET, ISAR-SMART 2 and ISAR-REACT 2. Common inclusion criteria were the presence of native coronary artery disease requiring PCI and pretreatment with 600 mg of clopidogrel at least 2 hours prior to the intervention. Patients were randomized to receive either the standard dose of abciximab plus unfractionated heparin or placebo plus unfractionated heparin. Bleeding was defined according to the Thrombolysis in Myocardial Infarction (TIMI) criteria. Primary end point was one-year mortality. Results: Within the first 30 days there were 314 myocardial infarctions (5.8%), 52 urgent revascularizations (1.0%) and 215 TIMI major or minor bleeding (4.0%). One-year mortality was 3.6% (n=197). Table shows one-year mortality among patients with or without 30-day adverse events (myocardial infarction, urgent revascularization or bleeding). Cox proportional hazard model that included all of the 3 adverse events along with baseline characteristics of the patients showed that 30-day myocardial infarction, urgent revascularization or bleeding were all independently associated with one-year mortality with adjusted hazard ratios displayed in the table . The prognostic value of bleeding was not dependent on its classification as major or minor. Conclusion: Our study supports the inclusion of post-procedural bleeding in a quadruple end point along with death, myocardial infarction and urgent revascularization to assess outcome after percutaneous coronary intervention. Table.

scholarly journals Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming Gao ◽  
Xinying Zhang ◽  
Ling Qin ◽  
Yang Zheng ◽  
Zhiguo Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Lower Discharge

Background. Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods. We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results. Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P<0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P=0.004) and in a confounder-adjusted model (HR per 1 g/L decrease in discharge Hb = 1.024, 95% CI: 1.011–1.037, P<0.001). The odds ratio (OR) for all-cause mortality at 2 years for participants with Hb below the twentieth percentile was 3.529 (95% CI: 1.976–6.302) and 2.968 (95% CI: 1.614–5.456) after adjustment for age and gender and 2.485 (95% CI: 1.310–4.715) after adjustment for all covariates. Conclusions. In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.

scholarly journals Individualising dual antiplatelet therapy after percutaneous coronary intervention: the IDEAL-PCI registry

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e005781 ◽  
Author(s):  
Günter Christ ◽  
Jolanta M Siller-Matula ◽  
Marcel Francesconi ◽  
Cornelia Dechant ◽  
Katharina Grohs ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Minor Bleeding ◽  
End Point ◽  
Percutaneous Coronary ◽  
St Elevation

ObjectiveTo evaluate the clinical utility of individualising dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in an all-comers population, including ST-elevation myocardial infarction (STEMI) patients.SettingTertiary care single centre registry.Participants1008 consecutive PCI patients with stent implantation, without exclusion criteria.InterventionPeri-interventional individualisation of DAPT, guided by multiple electrode aggregometry (MEA), to overcome high on-treatment platelet reactivity (HPR) to ADP-induced (≥50 U) and arachidonic acid (AA)-induced aggregation (>35 U).Outcome measuresThe primary efficacy end point was definite stent thrombosis (ST) at 30 days. The primary safety end point was thrombolysis in myocardial infarction (TIMI) major and minor bleeding. Secondary end points were probable ST, myocardial infarction, cardiovascular death and the combined end point: major cardiac adverse event (MACE).Results53% of patients presented with acute coronary syndrome (9% STEMI, 44% non-ST-elevation). HPR to ADP after 600 mg clopidogrel loading occurred in 30% of patients (73±19 U vs 28±11 U; p<0.001) and was treated by prasugrel or ticagrelor (73%), or clopidogrel (27%) reloading (22±12 U; p<0.001). HPR to ADP after prasugrel loading occurred in 2% of patients (82±26 U vs 19±10 U; p<0.001) and was treated with ticagrelor (34±15 U; p=0.02). HPR to AA occurred in 9% of patients with a significant higher proportion in patients with HPR to ADP (22% vs 4%, p<0.001) and was treated with aspirin reloading. Definite ST occurred in 0.09% of patients (n=1); probable ST, myocardial infarction, cardiovascular death and MACE occurred in 0.19% (n=2), 0.09% (n=1) and 1.8% (n=18) of patients. TIMI major and minor bleeding did not differ between patients without HPR and individualised patients (2.6% for both).ConclusionsIndividualisation of DAPT with MEA minimises early thrombotic events in an all-comers PCI population to an unreported degree without increasing bleeding. A randomised multicentre trial utilising MEA seems warranted.Trial registration numberhttp://www.clinicaltrials.gov; NCT01515345.

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