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Ann Cardiol Angeiol (Paris). 2013 Aug;62(4):227-32. doi: 10.1016/j.ancard.2013.03.005. Epub 2013 Apr 6.

[Prehospital treatment with bivalirudin in acute myocardial infarction referred for primary angioplasty. About 152 consecutive patients study].

[Article in French]

Author information

1
Service de cardiologie, centre hospitalier Émile-Muller, 20, rue du Docteur-Laennec, BP 1370, 68070 Mulhouse cedex, France. Electronic address: jacqueminl@ch-mulhouse.fr.

Abstract

OBJECTIVE OF THE STUDY:

Bivalirudin, a direct thrombin inhibitor, demonstrated an improvement in the prognosis of acute coronary syndromes by a decrease in major bleeding complications. This observational study evaluated inhospital outcome of patients with acute myocardial infarction treated by prehospital bivalirudin before primary angioplasty.

PATIENTS AND METHODS:

We included, from June 2010 to June 2012, all patients with acute myocardial infarction receiving prehospital bivalirudin with bolus of 0.75mg/kg followed by an infusion of 1.75mg/kg per hour until the arrival in the catheterization laboratory. Bivalirudin was possibly continued after primary angioplasty.

RESULTS:

We included 152 patients aged 57.6±11.6 years. A prehospital 60mg loading dose of prasugrel was given in 77% of patients. Coronary angiography with radial access (77.6%) was performed before a successful angioplasty in 97.3% of cases. The bivalirudin infusion was continued after the procedure in 81.6% of patients. Inhospital outcome showed two deaths (1.3%) and two re-infarctions (1.3%) of which one was related to the single acute stent thrombosis (0.6%). Major bleeding complications were limited irrespective of the Gusto (0.6%), Timi (0.6%) or Horizons-MI (4.6%) classification. Bleeding complications rate was similar when bivalirudin was followed or not after primary angioplasty.

CONCLUSION:

The use of bivalirudin in the prehospital setting for primary angioplasty seems to be effective and safe about ischemic and bleeding complications during the inhospital outcome.

KEYWORDS:

Angioplastie; Angioplasty; Bivalirudin; Bivalirudine; Infarction; Infarctus; Prehospital; Préhospitalier

PMID:
23806863
DOI:
10.1016/j.ancard.2013.03.005
[Indexed for MEDLINE]
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