ISAR-REACT 4: Abciximab-heparin combo, bivalirudin similarly reduced risk for death
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Two commonly used anti-clotting regimens, abciximab plus heparin and bivalirudin, were similarly effective in preventing death, subsequent MI or need for further revascularization in patients with non-ST-segment elevation MI undergoing percutaneous coronary intervention.
Among patients assigned to abciximab (ReoPro, Centocor and Eli Lilly) plus unfractionated heparin (n=861), 10.9% experienced the primary composite endpoint of death, large recurrent MI, urgent target vessel revascularization or major bleeding in 30 days vs. 11% of patients assigned to bivalirudin (n=860; RR=0.99; 95% CI, 0.74-1.32). The secondary endpoint of efficacy in death, any recurrent MI or urgent TVR was also similar with dual therapy (12.8%) compared with bivalirudin (13.4%; RR=0.96; 95% CI, 0.74-1.25).
Furthermore, patients taking the abciximab-heparin combination were more likely to experience major bleeding than those taking bivalirudin (4.6% vs. 2.6%; RR=1.84; 95% CI, 1.1-3.07).”.
“These findings … show that bivalirudin might be the preferred drug in patients undergoing PCI for an acute MI, with or without ST-segment elevation,” Adnan Kastrati, MD, professor of interventional cardiology at Technische Universitat, Munich, Germany, said at a press conference.
The double blind ISAR-REACT 4 study included 1,721 patients with acute non-ST-segment elevation MI.
“Understanding which treatment works better is important because non-ST-segment elevation MI patients are in danger of further cardiovascular problems,” Kastrati said in a press release. “The results of PCI in these patients are strongly dependent on the efficacy and safety of the anti-clotting drugs used during the procedure.” – by Casey Murphy
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