Efficacy and safety of prehospital administration of unfractionated heparin, enoxaparin or bivalirudin in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: Insights from the ORBI registry

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• 作者：Vincent Auffret^a ; ^b ; ^c ; ^{vincent.auffret@chu-rennes.fr} ; Guillaume Leurent^a ; ^b ; ^c ; Dominique Boulmier^a ; ^b ; ^c ; Marc Bedossa^a ; ^b ; ^c ; Amer Zabalawi^d ; Jean-Philippe Hacot^e ; Isabelle Coudert^f ; Emmanuelle Filippi^g ; Philippe Castellant^h ; ⁱ ; Antoine Rialan^j ; Gilles Rouault^k ; Philippe Druelles^l ; Bertrand Boulanger^m ; Josiane Treuilⁿ ; Bertrand Avez^o ; Marielle Le Guellec^a ; ^b ; ^c ; Martine Gilard^h ; ⁱ ; Hervé ; Le Breton^a ; ^b ; ^c
• 关键词：ST-segment elevation myocardial infarction ; Unfractionated heparin ; Enoxaparin ; Bivalirudin ; Outcomes
• 刊名：Archives of Cardiovascular Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：109
• 期：12
• 页码：696-707
• 全文大小：1028 K
• 卷排序：109

文摘

Despite numerous studies in recent years, the best anticoagulant option for primary percutaneous coronary intervention (PCI) remains a matter of debate.AimsTo compare in-hospital outcomes after prehospital administration of low-dose unfractionated heparin (UFH) ± glycoprotein IIb/IIIa inhibitors (GPIs), enoxaparin ± GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI).MethodsA total of 1720 patients (median age 62.0 years, 79.2% male) who had been enrolled in a prospective registry and received an injectable anticoagulant in physician-staffed mobile intensive care units before primary PCI were included in the study. The main outcomes were in-hospital major adverse cardiovascular events (MACE) (a composite of all-cause mortality, non-fatal myocardial infarction, stroke or definite stent thrombosis) and in-hospital major bleeding (Bleeding academic research consortium type 3 or 5).ResultsUFH was administered in 420 (24.4%) patients, enoxaparin in 1163 (67.6%) patients and bivalirudin in 137 patients (8.0%). Rates of in-hospital MACE were 7.4% with UFH, 6.0% with enoxaparin and 6.6% with bivalirudin, with no significant differences between groups (P = 0.628). In-hospital major bleeding occurred in 1.7% of patients on UFH, 1.4% on enoxaparin and 1.5% on bivalirudin (P = 0.851). By multivariable analysis, the prehospital anticoagulant used was not an independent predictor of MACE or major bleeding.ConclusionIn this prospective registry, there were no significant differences in the rates of in-hospital MACE or major bleeding after prehospital initiation of UFH, enoxaparin or bivalirudin in patients treated by primary PCI for STEMI.