Feature | November 01, 2013

Pre-Hospital Administration of Bivalirudin Improves Outcomes in Heart Attack Patients

Pre-hospital administration of bivalirudin improves outcomes in heart attack patients

November 1, 2013 — According to a new study, administering the blood thinner bivalirudin to patients experiencing an ST-elevation myocardial infarction (STEMI) in a pre-hospital setting can reduce the risk of death and major bleeding complications compared to heparin with optional use of glycoprotein IIb/IIIa inhibitors. Findings from the EUROMAX trial were reported at the 25th annual Transcatheter Cardiovascular Therapeutics scientific symposium (TCT 2013).
 
The EUROMAX trial evaluated the administration of anticoagulant therapy prior to hospital admission by an emergency medical team. The trial compared a heparin-based strategy (with or without glycoprotein IIb/IIIa receptor inhibitors (GPIs) to a bivalirudin-based strategy. The primary endpoint was a composite incidence of death or non-coronary-artery-bypass-graft related protocol major bleeding at 30 days, assessed by intention to treat. 
 
While bivalirudin has been compared to other blood thinners in hospital settings, the EUROMAX study is the first to evaluate these anticoagulant therapy options prior to hospital admission and in conjunction with newer P2Y12 inhibitors such as prasugrel and ticagrelor. The randomized, international, prospective, open-label ambulance trial enrolled 2,198 patients with STEMI and intended for primary percutaneous coronary intervention (PCI), presenting either via ambulance or to centers where PCI is not performed. 
 
Patients either received bivalirudin (n = 1,089) or heparin (n = 1,109) at guideline-recommended doses (with or without routine or bailout GPI). 
 
After 30 days, patients that received bivalirudin, as compared with the heparin group, experienced a significantly lower rate of death and major bleeding (5.1 percent versus 8.4 percent, respectively). The secondary composite outcome of death, reinfarction and major bleeding at 30 days was also reduced with bivalirudin (6.7 percent in the bivalirudin group compared to 9.1 percent in the heparin group). Despite a lower rate of bleeding complications in the bivalirudin-treated patients, the risk of acute stent thrombosis was higher in the bivalirudin group compared to the heparin group (1.1 percent versus 0.2 percent, respectively), findings that parallel those observed in the HORIZONS-AMI trial.
 
“The benefits of bivalirudin stemmed from a substantial reduction in major bleeding and were robust and consistent across subgroups, regardless of the adjunctive oral antiplatelet therapy or the arterial access route used for angioplasty,” said Philippe Gabriel Steg, M.D., director, coronary care unit, Hopital Bichat at Assistance Publique - Hôpitaux de Paris.
 
“Findings from EUROMAX provide important additional insights into the role of bivalirudin in the pre-hospital setting prior to primary PCI.”
 
For more information: www.crf.org, www.nejm.org

Related Content

Biotronik, BioMonitor 2 implantable cardiac monitor, BioInsight clinical study, first patients enrolled
News | Implantable Cardiac Monitor (ICM)| January 20, 2017
Biotronik has enrolled the first patients in the BioInsight clinical study evaluating the safety and feasibility of...
ICDs, non-ischemic cardiomyopathy, University of Alabama at Birmingham study, Circulation
News | Implantable Cardioverter Defibrillators (ICD)| January 18, 2017
A new study published in Circulation has found there is a 23 percent risk in reduction of all-cause mortality in non-...
stress, brain activity, cardiovascular risk, PET-CT, MGH, ISSMS, The Lancet study
News | Cardiac Diagnostics| January 18, 2017
A study led by Massachusetts General Hospital (MGH) and Icahn School of Medicine at Mount Sinai (ISSMS) investigators...
electronic health records, EHR, warfarin therapy management, University of Missouri Health Care, blood thinner
News | Antiplatelet and Anticoagulation Therapies| January 17, 2017
Warfarin is a commonly prescribed blood thinner used to prevent harmful blood clots. However, the drug requires...
ICDs, implantable cardioverter defibrillators, survival rate, elderly patients, JACC study
News | Implantable Cardioverter Defibrillators (ICD)| January 17, 2017
Of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac...
University of Utah, Frank Sachse, heart failure, LVAD implantation, left ventricular assist device, biomarker, t-system

Two patients may seem equally sick based upon clinical measures, but differences in their heart physiology could predict who has the potential to recover from heart failure. A study carried out by scientists at the University of Utah finds that patients whose hearts have flattened t-tubules have a decreased chance of showing signs of recovery after implanting a mechanical heart pump. Ordinarily, t-tubules in the heart are long, thin, and rounded. Image courtesy of Frank Sachse.

News | Cardiac Diagnostics| January 17, 2017
Investigators at the University of Utah have identified distinct differences in the hearts of advanced heart failure...
Synergy stent, abluminal polymer DES, bioresorbable polymer DES, bioresorbable polymer metallic stent

The Synergy stent is the first FDA cleared drug-eluting stent to use a bioresorbable polymer drug carrier. When the polymer dissolves after about four months, the devices become a bare metal stent. The technology is supposed to reduce the rate of late stent thrombosis due to vessel inflammation caused by durable polymers.

Feature | Stents Bioresorbable| January 17, 2017 | Dave Fornell
One of the big advancements in drug-eluting stent (DES) technology has been the development of bioresorbable polymers
St. Jude Medical, Amplatzer Amulet LAA Occluder, observational study, TCT 2016
News | Left Atrial Appendage (LAA) Occluders| November 03, 2016
St. Jude Medical Inc. presented favorable results from the largest observational study to date of the company’s...
Medtronic, CoreValve Evolut R TAVR system, U.S. IDE Study, TCT 2016
News | Heart Valve Technology| November 03, 2016
Medtronic plc unveiled new clinical data showing that patients treated with the self-expanding CoreValve Evolut R...
congenital heart patients, cardiac cath lab, anesthesia sedation practices, joint document, SCAI, SPA, CCAS
News | Congenital Heart| November 03, 2016
The Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the...
Overlay Init