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Radial access and risk guided use of bivalirudin?
Author(s) -
Ashley Kellan E.,
Hillegass William B.
Publication year - 2020
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.29358
Subject(s) - bivalirudin , medicine , conventional pci , percutaneous coronary intervention , cardiology , myocardial infarction , heparin , ejection fraction , heart failure
Key Points In radial access percutaneous coronary intervention (PCI) for acute coronary syndromes, study‐level meta‐analysis suggests no long‐term benefit of bivalirudin over heparin. Individual patient data meta‐analysis, however, suggests 28% lower cardiac mortality, 43% fewer serious bleeds, and 39% less non‐access site serious bleeds in ST‐elevation myocardial infarction (STEMI) patients with bivalirudin versus heparin adjusting for access site. Higher stent thrombosis risk with bivalirudin appears neutralized with post‐procedural infusion. Risk‐guided bivalirudin use with radial access in high‐risk PCI patients with STEMI, increased bleeding risk (>2%), and/or clinical heart failure/left ventricular ejection fraction (LVEF) <35% might improve outcomes and cost, warranting further study.