Bivalirudin has several potential advantages over unfractionated heparin: It does not rely on antithrombin to achieve its effects, it has a more predictable dose-response pattern (and, therefore, does not require routine blood test monitoring) and it has a short plasma half-life, which is important if a patient develops a bleeding problem.
For the study, Dr. Kastrati and his fellow ISAR-REACT 3 investigators recruited 4,570 low-to-intermediate-risk patients who were undergoing PCI for reasons other than heart attack, randomly assigning them to receive either unfractionated heparin or bivalirudin during the procedure. All patients received 600 mg of clopidogrel at least two hours before PCI, and all patients continued to take 75 mg of clopidogrel for at least one month after balloon angioplasty or implantation of bare-metal stents, and for at least six months after implantation of drug-eluting stents. Patients continued to take aspirin indefinitely.
The study will determine whether use of bivalirudin influences rates of bleeding during the initial hospitalization or the 30-day combined rates of death, heart attack or urgent procedure to reopen the treated artery.
"This population under study is important, as it reflects the predominant group undergoing PCI, perhaps up to 70 percent," said Dr. Kastrati. "Our results may clarify the paradigm for peri-procedural adjunctive therapy in this important group."
Dr. Kastrati will present the results of the "Intracoronary Stenting and Antithrombotic: Regimen Rapid Early Action for Coronary Treatment 3" (ISAR-REACT 3) study on Saturday, March 29 at 8:00 a.m. CDT in the Grand Ballroom, S100.
Headquartered in Washington, DC, the Society for Cardiovascular
Angiography and Interventions is a 4,000-member professional organization
representing invasive and interventional cardiologists in over 60 nations.
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