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Impact of anticoagulation regimen prior to revascularization in patients with non‐ ST ‐segment elevation acute coronary syndromes: The ACUITY trial
Author(s) -
Geisler Tobias,
Droppa Michal,
Gawaz Meinrad,
Steinhubl Steven R.,
Bertrand Michel E.,
Lincoff A. Michael,
Cequier Angel R.,
Desmet Walter,
Rasmussen Lars H.,
Hoekstra James W.,
Bernstein Debra,
Deliargyris Efthymios N.,
Mehran Roxana,
Stone Gregg W.
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26232
Subject(s) - medicine , mace , bivalirudin , interquartile range , acute coronary syndrome , percutaneous coronary intervention , clinical endpoint , cardiology , surgery , randomized controlled trial , myocardial infarction
Aim To evaluate the impact of antithrombotic regimens during the medical phase of treatment among 13,819 patients with non‐ST‐segment elevation acute coronary syndromes (NSTE‐ACS) treated with an early invasive strategy in the acute catheterization and urgent intervention triage strategy (ACUITY) trial. Methods and results Endpoints included composite major adverse cardiac events (MACE), major bleeding, and net adverse clinical events (NACE; MACE or major bleeding). The median (interquartile range) duration of antithrombin use in the medical only treatment phase was 6.5 (1.8–22.5) hours. MACE, major bleeding, and NACE during the medical only phase occurred in 63 (0.5%), 117 (0.9%), and 178 (1.3%) patients, respectively. MACE rates in the medical‐treatment‐only phase were not significantly different between the four randomized medical regimens used (heparin alone, bivalirudin alone, heparin plus a glycoprotein IIb/IIIa inhibitor [GPI], and bivalirudin plus GPI) ( P trend = 0.65). The lowest rates of major bleeding and NACE during the medical treatment phase occurred in patients treated with bivalirudin alone ( P trend = 0.0006 and P trend = 0.0004, respectively). Conclusions In patients with NSTE‐ACS undergoing an early invasive strategy, treatment with bivalirudin alone significantly reduced major bleeding and improved net clinical outcomes during the upstream medical management phase with comparable rates of MACE. © 2015 Wiley Periodicals, Inc.