Coronary artery diseaseSafety and Efficacy of Prasugrel Use in Patients Undergoing Percutaneous Coronary Intervention and Anticoagulated With Bivalirudin
Section snippets
Methods
We included 692 consecutive patients with acute coronary syndrome. From January 2010 to September 2011, all underwent PCI with stent implantation using intraprocedural bivalirudin anticoagulation. Patients were identified from an ongoing registry of coronary interventions kept at our institution. Patients with contraindications to, or cautions about, either clopidogrel or prasugrel were excluded.
We compared the clinical, procedural, and follow-up information for patients receiving prasugrel to
Results
Before the availability of prasugrel, clopidogrel was the standard antiplatelet agent in our laboratory. Consequently, 596 patients (86.1%) in the present study cohort received clopidogrel and 96 patients (13.9%) received prasugrel during PCI. The baseline demographic and clinical characteristics were similar (Table 1). Significantly fewer white patients were treated with clopidogrel (p = 0.01) and a greater proportion of patients had hypertension (p = 0.04) and renal insufficiency (p = 0.05)
Discussion
The present short-term study was undertaken to examine the possibility that the excess bleeding encountered with prasugrel in the TRITON-TIMI 38 trial5 was related not to the antiplatelet agent, but rather to the heparin plus glycoprotein IIb/IIIa inhibitor combination used for anticoagulation during PCI. We postulated that the known advantage of bivalirudin over heparin in procedure-related bleeding might offset this disadvantage. To date, no randomized trial has addressed this hypothesis,
Disclosures
The authors have disclosed no conflicts of interest.
References (10)
- et al.
A comparison of the clinical impact of bleeding measured by two different classifications among patients with acute coronary syndromes
J Am Coll Cardiol
(2006) - et al.
Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina: final report reanalysis of the Bivalirudin Angioplasty Study
Am Heart J
(2001) - et al.
Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial
JAMA
(2003) - et al.
Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial
JAMA
(2004) - et al.
Bivalirudin for patients with acute coronary syndromes
N Engl J Med
(2006)
Cited by (4)
Thirty-day safety and efficacy of prasugrel versus clopidogrel in patients undergoing percutaneous coronary intervention for non-urgent indications and anticoagulated with bivalirudin
2014, IJC Metabolic and EndocrineCitation Excerpt :In TRITON-TIMI 38, bivalirudin was administrated in only 3% of trial subjects undergoing PCI for acute coronary syndrome. Other smaller studies evaluated the efficacy and safety of prasugrel compared to clopidogrel in patients undergoing PCI for acute coronary syndrome and are anticoagulated with bivalirudin [5]. In our clinical practice, bivalirudin is the anticoagulant of choice for both ACS as well as routine PCI, and the majority of procedures performed are for non-acute diagnoses.
Prasugrel and ticagrelor: Is there a winner?
2014, Journal of Cardiovascular Medicine
See page 519 for disclosure information.