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CONCLUSION: [[Bivalirudin]] is an excellent choice in most [[NSTEMI]]/[[UA]] patients managed with an early invasive strategy if they have been pre-treated with [[clopidogrel]]. If this has not been done then [[coagulation|2b/3a]] will need to be used and the benefits of [[bivalirudin]] are greatly attenuated.
CONCLUSION: [[Bivalirudin]] is an excellent choice in most [[NSTEMI]]/[[UA]] patients managed with an early invasive strategy if they have been pre-treated with [[clopidogrel]]. If this has not been done then [[coagulation|2b/3a]] will need to be used and the benefits of [[bivalirudin]] are greatly attenuated.
 
==2021 ACA Revascularization Guideline==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|Class 1 Recommendation, Level of Evidence: C-EO<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref>
|-
| bgcolor="LightGreen"|Administration of [[intravenous]] [[heparin|unfractionated heparin]] ([[heparin|UFH]]) is useful in reducing [[ischemia|ischemia events]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Yellow"|Class 1 Recommendation, Level of Evidence: C-LD<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref><ref name="pmid12357516">{{cite journal| author=Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F | display-authors=etal| title=Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. | journal=Catheter Cardiovasc Interv | year= 2002 | volume= 57 | issue= 2 | pages= 177-84 | pmid=12357516 | doi=10.1002/ccd.10276 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12357516  }} </ref><ref name="pmid14608128">{{cite journal| author=Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA | display-authors=etal| title=The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results. | journal=J Invasive Cardiol | year= 2003 | volume= 15 | issue= 11 | pages= 611-6 | pmid=14608128 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14608128  }} </ref>
|-
| bgcolor="Yellow"|[[Bivalirudin]] or [[argatroban]] should be used instead of [[UFH]] in [[patients]] with [[heparin-induced thrombocytopenia]] who are undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:Lightblue"|Class 2b Recommendation, Level of Evidence: A<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref><ref name="pmid18703471">{{cite journal| author=Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ | display-authors=etal| title=Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 7 | pages= 688-96 | pmid=18703471 | doi=10.1056/NEJMoa0802944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18703471  }} </ref><ref name="pmid12588269">{{cite journal| author=Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD | display-authors=etal| title=Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. | journal=JAMA | year= 2003 | volume= 289 | issue= 7 | pages= 853-63 | pmid=12588269 | doi=10.1001/jama.289.7.853 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588269  }} </ref><ref name="pmid17368152">{{cite journal| author=Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT | display-authors=etal| title=Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. | journal=Lancet | year= 2007 | volume= 369 | issue= 9565 | pages= 907-19 | pmid=17368152 | doi=10.1016/S0140-6736(07)60450-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17368152  }} </ref><ref name="pmid22077909">{{cite journal| author=Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M | display-authors=etal| title=Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 21 | pages= 1980-9 | pmid=22077909 | doi=10.1056/NEJMoa1109596 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22077909  }} </ref><ref name="pmid25791214">{{cite journal| author=Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T | display-authors=etal| title=Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. | journal=Lancet | year= 2015 | volume= 385 | issue= 9986 | pages= 2465-76 | pmid=25791214 | doi=10.1016/S0140-6736(15)60292-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25791214  }} </ref><ref name="pmid24171490">{{cite journal| author=Steg PG, van 't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P | display-authors=etal| title=Bivalirudin started during emergency transport for primary PCI. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 23 | pages= 2207-17 | pmid=24171490 | doi=10.1056/NEJMoa1311096 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24171490  }} </ref><ref name="pmid18499566">{{cite journal| author=Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D | display-authors=etal| title=Bivalirudin during primary PCI in acute myocardial infarction. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 21 | pages= 2218-30 | pmid=18499566 | doi=10.1056/NEJMoa0708191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18499566  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=18783187 Review in: ACP J Club. 2008 Sep 16;149(3):11] </ref><ref name="pmid25746943">{{cite journal| author=Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW| title=Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials. | journal=Eur Heart J Acute Cardiovasc Care | year= 2016 | volume= 5 | issue= 3 | pages= 253-62 | pmid=25746943 | doi=10.1177/2048872615572599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746943  }} </ref><ref name="pmid25131979">{{cite journal| author=Cavender MA, Sabatine MS| title=Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2014 | volume= 384 | issue= 9943 | pages= 599-606 | pmid=25131979 | doi=10.1016/S0140-6736(14)61216-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25131979  }} </ref><ref name="pmid30636368">{{cite journal| author=Shah R, Latham SB, Porta JM, Naz A, Matin K, Rao SV| title=Bivalirudin with a post-procedure infusion versus heparin monotherapy for the prevention of stent thrombosis. | journal=Catheter Cardiovasc Interv | year= 2019 | volume= 94 | issue= 2 | pages= 210-215 | pmid=30636368 | doi=10.1002/ccd.28065 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30636368  }} </ref>
|-
| bgcolor="Lightblue"|[[Bivalirudin]] could be used as a reasonable alternative to [[UFH]] in order to reduce [[bleeding]] in [[patients]] undergoing [[PCI]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightgray"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref>
|-
| bgcolor="lightgray"|Weigh the risk of [[coronary angiography]] and [[revascularization]] against the benefits of them for [[chronic kidney disease]] [[patients]] with low risk non-[[ST elevation myocardial infarction]].
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:lightpink"|Class 2a Recommendation, Level of Evidence: B-NR<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950  }} </ref>
|-
| bgcolor="lightpink"|[[Coronary angiography]] and [[revascularization]] are not recommended as a routine for [[chronic kidney disease]] [[patients]] with non-[[ST elevation myocardial infarction]] who are stable and [[symtoms|asymptomatic]].
|}
==ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
==ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>==
===Use of Parenteral Anticoagulants during PCI (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===
===Use of Parenteral Anticoagulants during PCI (DO NOT EDIT)<ref name="pmid22070837">{{cite journal |author=Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH |title=2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=24 |pages=2550–83|year=2011|month=December|pmid=22070837|doi=10.1016/j.jacc.2011.08.006|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02875-0|accessdate=2011-12-08|url=http://content.onlinejacc.org/cgi/reprint/58/24/2550.pdf|PDF}}</ref>===

Revision as of 20:51, 27 July 2022

Percutaneous coronary intervention Microchapters

Home

Patient Information

Overview

Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

Vascular Closure Devices

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

PCI approaches

PCI Complications

Factors Associated with Complications
Vessel Perforation
Dissection
Distal Embolization
No-reflow
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Restenosis
Renal Failure
Thrombocytopenia
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
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Left Main Intervention
The Thrombotic Lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Antithrombin Therapy to Support PCI

Unfractionated Heparin (UFH)

IV unfractionated heparin is the most common anticoagulant used in the cath lab.

Mechanism of action

Heparin is a glycosaminoglycan of 12-15 kDa that binds Anti-thrombin 3 and facilitates its ability to inhibit coagulation factors 2a (thrombin) and 10a by a factor of 1000. Thrombin plays a central role not only in plasma coagulation (by catalysing fibrinogen to fibrin as well as activating several coagulation factors) but platelet activation as well.

Advantages

and 250-350 without 2b/3a (these levels have been empirically derived and target ACT's have fallen in the stent era as the risk for acute vessel closure has diminished)

Disadvantages

Low Molecular Weight Heparinoids (LMWH)

Mechanism of Action

Bivalirudin (Angiomax) is the only DTI used commonly in the cath lab although the others have been studied.

Advantages

Disadvantages

Trials with Bivalirudin

Replace 2: This trial compared bivalirudin plus provisional 2b/3a (which ended up being given in 7.2% of patients) vs heparin with planned 2b/3a. In this study of 6010 patients, ischemic events were similar but major bleeding (mostly vascular access site) was reduced by about 40%. There was no mortality difference at one year despite a 0.8% absolute increase in peri-procedural MI's in the bivalirudin group. Importantly ,85% of patients were pre-treated with plavix or ticlid. In Replace 2, bivalirudin strategy was found to be less expensive because of savings on 2b/3a as well as less bleeding.

ACUITY: Complex trial of 13,819 high risk UA or NSTEMI patients undergoing early invasive strategy comparing bivalirudin alone vs Bivalirudin with 2b/3a vs Heparin or Lovenox with 2b/3a. It was found that the ischemic composite endpoint (death, MI, revascularization) at 30 days was the same in all 3 arms. However, major bleeding was significantly less with bivalirudin alone at 3.1% vs bivalirudin and 2b/3a at 5.3% vs Heparin, Lovenox and 2b/3a at 5.7%. Again this was driven mostly by access site complications, but unlike in REPLACE 2 the bleeding end points were significant whether one used the study definition or TIMI definition. A major caveat is also that patients who did not get plavix had increased ischemic events in the bivalirudin only arm.

CONCLUSION: Bivalirudin is an excellent choice in most NSTEMI/UA patients managed with an early invasive strategy if they have been pre-treated with clopidogrel. If this has not been done then 2b/3a will need to be used and the benefits of bivalirudin are greatly attenuated.

2021 ACA Revascularization Guideline

Class 1 Recommendation, Level of Evidence: C-EO[1]
Administration of intravenous unfractionated heparin (UFH) is useful in reducing ischemia events in patients undergoing PCI.
Class 1 Recommendation, Level of Evidence: C-LD[1][2][3]
Bivalirudin or argatroban should be used instead of UFH in patients with heparin-induced thrombocytopenia who are undergoing PCI.
Class 2b Recommendation, Level of Evidence: A[1][4][5][6][7][8][9][10][11][12][13]
Bivalirudin could be used as a reasonable alternative to UFH in order to reduce bleeding in patients undergoing PCI.
Class 2a Recommendation, Level of Evidence: B-NR[1]
Weigh the risk of coronary angiography and revascularization against the benefits of them for chronic kidney disease patients with low risk non-ST elevation myocardial infarction.
Class 2a Recommendation, Level of Evidence: B-NR[1]
Coronary angiography and revascularization are not recommended as a routine for chronic kidney disease patients with non-ST elevation myocardial infarction who are stable and asymptomatic.

ACCF/AHA/SCAI 2011 Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[14]

Use of Parenteral Anticoagulants during PCI (DO NOT EDIT)[14]

Class I
"1. An anticoagulant should be administered to patients undergoing PCI. (Level of Evidence: C)"

Unfractionated Heparin (DO NOT EDIT)[14]

Class I
"1. Administration of intravenous UFH is useful in patients undergoing PCI. (Level of Evidence: C)"

Enoxaparin (DO NOT EDIT)[14]

Class I
"1. An additional dose of 0.3 mg/kg intravenous enoxaparin should be administered at the time of PCI to patients who have received fewer than 2 therapeutic subcutaneous doses (e.g., 1 mg/kg) or received the last subcutaneousenoxaparin dose 8 to 12 hours before PCI.[15][16][17][18][19](Level of Evidence: B)"
Class III (Harm)
"1. Unfractionated heparin (UFH) should not be given to patients already receiving therapeutic subcutaneous enoxaparin.[15][20](Level of Evidence: B)"
Class IIb
"1. Performance of PCI with enoxaparin may be reasonable in patients either treated with upstream subcutaneous enoxaparin forUA/NSTEMI or who have not received prior antithrombin therapy and are administered intravenous enoxaparin at the time ofPCI.[21][22][15][23] (Level of Evidence: B)"

Bivalirudin and Argatoban (DO NOT EDIT)[14]

Class I
"1. For patients undergoing PCI, bivalirudin is useful as an anticoagulant with or without prior treatment with unfractionated heparin (UFH).[24][25][4][26][27][28][29][10][30](Level of Evidence: B)"
"2. For patients with heparin-induced thrombocytopenia, it is recommended that bivalirudin or argatroban be used to replace unfractionated heparin (UFH).[2][3] (Level of Evidence: B)"

Fondaparinux (DO NOT EDIT)[14]

Class III (No Benefit)
"1. Fondaparinux should not be used as the sole anticoagulant to support PCI. An additional anticoagulant with anti-IIa activity should be administered because of the risk of catheter thrombosis.[31][32](Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check |pmid= value (help).
  2. ↑ 2.0 2.1 Lewis BE, Matthai WH, Cohen M, Moses JW, Hursting MJ, Leya F; et al. (2002). "Argatroban anticoagulation during percutaneous coronary intervention in patients with heparin-induced thrombocytopenia". Catheter Cardiovasc Interv. 57 (2): 177–84. doi:10.1002/ccd.10276. PMID 12357516.
  3. ↑ 3.0 3.1 Mahaffey KW, Lewis BE, Wildermann NM, Berkowitz SD, Oliverio RM, Turco MA; et al. (2003). "The anticoagulant therapy with bivalirudin to assist in the performance of percutaneous coronary intervention in patients with heparin-induced thrombocytopenia (ATBAT) study: main results". J Invasive Cardiol. 15 (11): 611–6. PMID 14608128.
  4. ↑ 4.0 4.1 Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Büttner HJ; et al. (2008). "Bivalirudin versus unfractionated heparin during percutaneous coronary intervention". N Engl J Med. 359 (7): 688–96. doi:10.1056/NEJMoa0802944. PMID 18703471.
  5. ↑ Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD; et al. (2003). "Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial". JAMA. 289 (7): 853–63. doi:10.1001/jama.289.7.853. PMID 12588269.
  6. ↑ Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT; et al. (2007). "Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial". Lancet. 369 (9565): 907–19. doi:10.1016/S0140-6736(07)60450-4. PMID 17368152.
  7. ↑ Kastrati A, Neumann FJ, Schulz S, Massberg S, Byrne RA, Ferenc M; et al. (2011). "Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction". N Engl J Med. 365 (21): 1980–9. doi:10.1056/NEJMoa1109596. PMID 22077909.
  8. ↑ Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T; et al. (2015). "Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial". Lancet. 385 (9986): 2465–76. doi:10.1016/S0140-6736(15)60292-6. PMID 25791214.
  9. ↑ Steg PG, van 't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P; et al. (2013). "Bivalirudin started during emergency transport for primary PCI". N Engl J Med. 369 (23): 2207–17. doi:10.1056/NEJMoa1311096. PMID 24171490.
  10. ↑ 10.0 10.1 Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D; et al. (2008). "Bivalirudin during primary PCI in acute myocardial infarction". N Engl J Med. 358 (21): 2218–30. doi:10.1056/NEJMoa0708191. PMID 18499566. Review in: ACP J Club. 2008 Sep 16;149(3):11
  11. ↑ Capodanno D, Gargiulo G, Capranzano P, Mehran R, Tamburino C, Stone GW (2016). "Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI: An updated meta-analysis of 10,350 patients from five randomized clinical trials". Eur Heart J Acute Cardiovasc Care. 5 (3): 253–62. doi:10.1177/2048872615572599. PMID 25746943.
  12. ↑ Cavender MA, Sabatine MS (2014). "Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials". Lancet. 384 (9943): 599–606. doi:10.1016/S0140-6736(14)61216-2. PMID 25131979.
  13. ↑ Shah R, Latham SB, Porta JM, Naz A, Matin K, Rao SV (2019). "Bivalirudin with a post-procedure infusion versus heparin monotherapy for the prevention of stent thrombosis". Catheter Cardiovasc Interv. 94 (2): 210–215. doi:10.1002/ccd.28065. PMID 30636368.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  15. ↑ 15.0 15.1 15.2 Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H (2004). "Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial". JAMA : the Journal of the American Medical Association. 292 (1): 45–54. doi:10.1001/jama.292.1.45. PMID 15238590. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  16. ↑ Cohen M, Levine GN, Pieper KS, Lan L, Antman EM, Aylward PE, White HD, Kleiman NS, Califf RM, Mahaffey KW (2010). "Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: a subgroup analysis from the SYNERGY trial". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 75 (6): 928–35. doi:10.1002/ccd.22340. PMID 20432399. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  17. ↑ Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, Beygui F, Drobinski G, Vignolles N, Thomas D (2004). "Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes". American Heart Journal. 147 (4): 655–61. doi:10.1016/j.ahj.2003.10.019. PMID 15077081. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  18. ↑ Levine GN, Ferrando T (2004). "Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention" (PDF). Journal of Thrombosis and Thrombolysis. 17 (3): 167–71. doi:10.1023/B:THRO.0000040484.99422.77. PMID 15353913. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  19. ↑ Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ, Ozoux ML, Pensyl CE, Bigonzi F (2004). "Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 61 (2): 163–70. doi:10.1002/ccd.10726. PMID 14755805. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  20. ↑ Drouet L, Bal dit Sollier C, Martin J (2009). "Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study". American Heart Journal. 158 (2): 177–84. doi:10.1016/j.ahj.2009.05.022. PMID 19619692. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  21. ↑ Brieger D, Collet JP, Silvain J, Landivier A, Barthélémy O, Beygui F, Bellemain-Appaix A, Mercadier A, Choussat R, Vignolles N, Costagliola D, Montalescot G (2011). "Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 77 (2): 182–90. doi:10.1002/ccd.22674. PMID 20578166. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  22. ↑ Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V, Drobinski G, Sotirov I, Thomas D (2002). "A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention". Journal of the American College of Cardiology. 40 (11): 1943–50. PMID 12475453. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  23. ↑ Montalescot G, Gallo R, White HD, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR (2009). "Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention 1-year results from the STEEPLE (SafeTy and efficacy of enoxaparin in percutaneous coronary intervention patients, an international randomized evaluation) trial". JACC. Cardiovascular Interventions. 2 (11): 1083–91. doi:10.1016/j.jcin.2009.08.016. PMID 19926048. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  24. ↑ De Luca G, Cassetti E, Verdoia M, Marino P (2009). "Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: A meta-analyis of randomised trials". Thrombosis and Haemostasis. 102 (3): 428–36. doi:10.1160/TH09-05-0287. PMID 19718462. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  25. ↑ Lincoff AM, Steinhubl SR, Manoukian SV, Chew D, Pollack CV, Feit F, Ware JH, Bertrand ME, Ohman EM, Desmet W, Cox DA, Mehran R, Stone GW (2008). "Influence of timing of clopidogrel treatment on the efficacy and safety of bivalirudin in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention: an analysis of the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial". JACC. Cardiovascular Interventions. 1 (6): 639–48. doi:10.1016/j.jcin.2008.10.004. PMID 19463378. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  26. ↑ Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ (2004). "Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial". JAMA : the Journal of the American Medical Association. 292 (6): 696–703. doi:10.1001/jama.292.6.696. PMID 15304466. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  27. ↑ Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW (2009). "Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial". Lancet. 374 (9696): 1149–59. doi:10.1016/S0140-6736(09)61484-7. PMID 19717185. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  28. ↑ Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, Richardt G, Berger PB, Schömig A, Kastrati A (2010). "Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial". European Heart Journal. 31 (5): 582–7. doi:10.1093/eurheartj/ehq008. PMID 20150324. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  29. ↑ Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM (2006). "Bivalirudin for patients with acute coronary syndromes". The New England Journal of Medicine. 355 (21): 2203–16. doi:10.1056/NEJMoa062437. PMID 17124018. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  30. ↑ Dangas G, Mehran R, Guagliumi G, Caixeta A, Witzenbichler B, Aoki J, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Rabbani LE, Parise H, Stone GW (2009). "Role of clopidogrel loading dose in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: results from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial". Journal of the American College of Cardiology. 54 (15): 1438–46. doi:10.1016/j.jacc.2009.06.021. PMID 19796737. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  31. ↑ Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA (2006). "Comparison of fondaparinux and enoxaparin in acute coronary syndromes". The New England Journal of Medicine. 354 (14): 1464–76. doi:10.1056/NEJMoa055443. PMID 16537663. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  32. ↑ Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA (2006). "Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial". JAMA :the Journal of the American Medical Association. 295 (13): 1519–30. doi:10.1001/jama.295.13.joc60038. PMID 16537725. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)

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