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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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\u003EBivalirudin failed to show a superior \u201cnet clinical benefit\u201d compared with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention in the Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment 3 [ISAR-REACT 3] trial. However, bivalirudin reduced the rate of major and minor bleeding events in this patient population.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EBivalirudin failed to show a superior \u201cnet clinical benefit\u201d compared with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) in the Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment 3 (ISAR-REACT 3) trial. However, bivalirudin reduced the rate of major and minor bleeding events in this patient population.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIn the ISAR-REACT 3 trial, 4570 patients with biomarker-negative stable or unstable angina were randomly assigned to treatment with bivalirudin (n=2289) or UFH (n=2281) prior to scheduled PCI. All patients received clopidogrel 600 mg at least 2 hours before PCI and at least 325 mg oral or intravenous aspirin. Bivalirudin was administered as a 0.75 mg\/kg loading dose followed by 1.75 mg\/kg\/hr infusion. Patients in the UFH group received a 140 U\/kg bolus followed by placebo infusion.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EFollowing PCI, patients received clopidogrel 75\u2013150 mg\/day until discharge (\u22643 days) and 75 mg\/day for at least 1 month after balloon angioplasty or implantation of bare-metal stents and for at least 6 months after implantation of drug-eluting stents. All patients received aspirin 80\u2013325 mg\/day indefinitely. At 30 days, the cumulative incidence of death, myocardial infarction, urgent target vessel revascularization, and major bleeding (the primary endpoint) in the bivalirudin and UFH groups was 8.3% and 8.7%, respectively (RR 0.94; p=0.57; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Net Clinical Benefit of Bivalirudin and UFH.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-889788698\u0022 data-figure-caption=\u0022Net Clinical Benefit of Bivalirudin and UFH.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11124\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ENet Clinical Benefit of Bivalirudin and UFH.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDespite similarities in net clinical benefit, bivalirudin showed a clear advantage over 140 U\/kg UFH with regard to risk of bleeding. Compared with those in the UFH group, bivalirudin-treated patients had a significantly lower rate of major bleeding (3.1% vs 4.6%; p=0.008) and minor bleeding (6.8% vs 9.9%; p=0.0001).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\u201cBleeding is important to patient outcomes,\u201d said Harvey White, MD, Auckland City Hospital, Auckland, New Zealand. \u201cStrikingly, bivalirudin reduced TIMI major bleeding by 50 percent.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EStill, \u201cISAR-REACT 3 was powered for its primary endpoint, so conclusions should focus on the primary endpoint,\u201d said lead study author Adnan Kastrati, MD, Technische Universit\u00e4t, Munich, Germany. Dr. Kastrati cautioned that because the dose of UFH (140 U\/kg) was higher in ISAR-REACT 3 than that used in other recent PCI trials and the dose (70\u2013100 U\/kg) recommended in current PCI guidelines in the absence of GP IIb\/IIIa inhibitors [Smith.\u003Cem\u003ECirculation\u003C\/em\u003E 2006], it was not clear how much of an effect the higher UFH dose had on the observed ischemic or bleeding event rates in the trial.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDr. White noted that the ISAR-REACT 3 results should not be generalized to patients with higher ischemic risk, such as those with elevated troponin levels, acute MI, or recent CABG. Furthermore, the findings are not applicable to patients who have not received 600 mg clopidogrel \u22652 hours before PCI, he concluded.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 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\/8\/2\/8.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_figures.js?nzmfsd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmfsd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}