Improved Anti-clotting for Cardiac Emergency Therapy

Researchers at the Columbia University Medical Center (CUMC, New York, NY, USA), the New York-Presbyterian Hospital (NYP, NY, USA), and other centers enrolled 13,819 study participants in 17 countries in a trial called ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy). They divided the patients into one of three treatment groups. One group received one of two types of the standard treatment, heparin, either unfractionated heparin (UFH) or the low-molecular weight heparin enoxaparin, combined with glycoprotein (GP) IIb/IIIa platelet inhibitors. A second group received bivalirudin and GPIIb/IIIa inhibitors. A third group received bivalirudin alone.

The researchers found that when used by itself to treat cardiac emergencies known as acute coronary syndromes (ACS), bivalrudin reduced the risk of major bleeding, a key risk for mortality, by 47% compared with patients treated with heparin and GPIIb/IIIa inhibitors. Patients who received bivalirudin alone had similar rates of ischemic complications--heart attack, the need for repeat procedures for artery reblockages, or death--as the other groups.

"Use of bivalirudin alone rather than the more traditional anticoagulants in ACS patients could prevent a significant number of major bleeding episodes and blood transfusions every year in the U.S. [United States] and elsewhere,” said lead author Dr. Gregg Stone, M.D., director of research and education for the Center for Interventional Vascular Therapy at CUMC and NYP.

Bivalrudin, manufactured by The Medicines Company (MDCO, Parsippany, NJ , USA) under the brand name Angiomax, has been approved to replace heparin in non-emergency angioplasty procedures, but had not been tested in more critical emergency situations, such as ACS.



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Columbia University Medical Center
New York-Presbyterian Hospital
The Medicines Company