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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EUnfractionated heparin, at a dose of 100 U\/kg, is preferable to standard higher-dose treatment in patients who are undergoing elective percutaneous coronary intervention, according to new findings from the Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment 3A [ISAR-REACT 3A; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00735280\u0026amp;atom=%2Fspmdc%2F10%2F8%2F13.atom\u0022\u003ENCT00735280\u003C\/a\u003E] trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EUnfractionated heparin (UFH), at a dose of 100 U\/kg, is preferable to standard higher-dose treatment in patients who are undergoing elective percutaneous coronary intervention (PCI), according to new findings from the Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment 3A (ISAR-REACT 3A; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00735280\u0026amp;atom=%2Fspmdc%2F10%2F8%2F13.atom\u0022\u003ENCT00735280\u003C\/a\u003E) trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough 140 U\/kg has been the standard dose for UFH in interventional cardiology for decades, physicians have started to use lower doses of UFH to decrease the risk of bleeding, said Stefanie Schulz, MD, Deutsches Herzzentrum, Munich, Germany. Dr. Schulz presented results of the ISAR-REACT 3A trial, which confirmed the benefits of lower-dose UFH in patients who are undergoing elective PCI.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the ISAR-REACT 3A trial, 2505 biomarker-negative patients who were undergoing elective PCI were treated with a bolus dose of UFH 100 U\/kg without activated clotting time (ACT) monitoring. This treatment group was compared with two historical control groups from the main ISAR-REACT 3 trial, including patients who were treated with a bolus dose of UFH 140 U\/kg (n=2281) or with bivalirudin (n=2289) [Kastrati A et al. \u003Cem\u003EN Eng J Med\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the ISAR-REACT 3 trial, treatment with bivalirudin significantly reduced the risk of minor bleeding (6.8% vs 9.9%; p=0.0001) and major bleeding (3.1% vs 4.6%; p=0.008) compared with UFH 140 U\/kg in patients who were undergoing elective PCI. However, the net clinical benefit, which accounted for death, myocardial infarction (MI), urgent target vessel revascularization (TVR), and major bleeding, was similar in the bivalirudin and UFH 140 U\/kg groups at 30 days (8.3% vs 8.7%; p=0.57) [Kastrati A et al. \u003Cem\u003EN Eng J Med\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the current ISAR-REACT 3A study, the net clinical benefit at 30 days favored treatment with UFH 100 U\/kg compared with UFH 140 U\/kg (7.3% vs 8.7%; p=0.007). Although the 100-U\/kg and 140-U\/kg dosing groups were associated with similar rates of death, MI, or urgent TVR (4.4% vs 5.0%; p=0.15), the risk of major bleeding was 29% lower in the 100-U\/kg dosing group (3.6% vs 4.6%; p=0.03).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn the second comparison, treatment with UFH 100 U\/kg met the criteria for noninferiority compared with bivalirudin. Low-dose UFH and bivalirudin had similar rates of death, MI, or urgent TVR (4.4% vs 5.9%), as well as similar rates of major (3.6% vs 3.1%) and minor bleeding (6.2% vs 6.8%).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EFindings from the ISAR-REACT 3A trial support a shift in practice for biomarker-negative patients who receive elective PCI. Reducing the UFH dose from 140 U\/kg to 100 U\/kg provides a superior net clinical benefit for PCI patients and is noninferior to treatment with bivalirudin, Dr. Schulz concluded.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/8\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmotd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}