English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Zendy Open

Presents the pdf analysis as premium feature

PDF Analysis

Insights

Presents the summarisation as premium feature

Summarisation

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the zaia usage as premium feature

ZAIA

Zendy Tools

Zendy Plus

Presents the access of premium content as premium feature

Premium Content

Background  The optimal antithrombotic therapy in patients with  ST ‐segment‐elevation myocardial infarction undergoing primary percutaneous coronary intervention ( PCI ) remains a matter of debate. This updated meta‐analysis investigated the impact of (1) bivalirudin (with and without prolonged infusion) and (2) prolonged  PCI ‐dose (1.75 mg/hg per hour) bivalirudin infusion compared with conventional antithrombotic therapy on clinical outcomes in patients undergoing primary  PCI .    Methods and Results  Eligible randomized trials were searched through  MEDLINE ,  EMBASE , Cochrane database, and proceedings of major congresses. Prespecified outcomes were major bleeding (thrombolysis in myocardial infarction major and Bleeding Academic Research Consortium 3–5), acute stent thrombosis, as well as all‐cause and cardiac mortality at 30 days. Six randomized trials (n=17 294) were included. Bivalirudin compared with heparin (+/− glycoprotein‐ II b/ III a inhibitor) was associated with reduction in major bleeding (odds ratio [ OR ]: 0.65, 95%  CI : 0.48–0.88,  P =0.006, derived from all 6 trials), increase in acute stent thrombosis ( OR : 2.75, 95%  CI : 1.46–5.18,  P =0.002, 5 trials), and lower rate of all‐cause mortality ( OR : 0.81, 95%  CI : 0.67–0.98,  P =0.03, 6 trials) as well as cardiac mortality ( OR : 0.69, 95%  CI : 0.55–0.87,  P =0.001, 5 trials). The incidence of acute stent thrombosis did not differ between the prolonged  PCI ‐dose bivalirudin and comparator group ( OR : 0.81, 95%  CI : 0.27–2.46,  P =0.71, 3 trials), whereas the risk of bleeding was reduced despite treatment with high‐dose bivalirudin infusion ( OR : 0.28, 95%  CI : 0.13–0.60,  P =0.001, 3 trials).    Conclusions  Bivalirudin (with and without prolonged infusion) compared with conventional antithrombotic therapy in  ST ‐segment‐elevation myocardial infarction patients undergoing primary  PCI  reduces major bleeding and death, but increases the rate of acute stent thrombosis. However, prolonging the bivalirudin infusion at  PCI ‐dose (1.75 mg/kg per hour) for 3 hours eliminates the excess risk of acute stent thrombosis, while maintaining the bleeding benefits.

journal of the american heart association

Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis