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Bivalirudin in contemporary ST elevation myocardial infarction treatment
The novel direct thrombin inhibitor bivalirudin is now widely used as an adjunctive therapy in patients undergoing primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). This stems from trial data demonstrating bivalirudin results in lower bleeding rates and better long term survival as compared with the combination of heparin and a glycoprotein IIb/IIIa inhibitor. However, clinical practice has subsequently changed, including greater use of radial access with resultant lower bleeding risk and expanded use of newer generation P2Y12 inhibitors. The EUROMAX trial sought to understand whether use of bivalirudin benefits patients in light of these changes in clinical practices.
This trial prospectively randomised 2218 patients in an open-label fashion to treatment with bivalirudin or heparin with optional use GP IIb/IIIa (decision left to provider preference) inhibitor by paramedic teams during ambulance transfer to a PCI centre. Approximately 50% of procedures were completed radially with 60% of patients being loaded with one of the novel P2Y12 antagonists. Nearly 70% of patients in the heparin group received a GP IIb/IIIa inhibitor compared to just over 10% in the bivalirudin treated group. The …
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