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Efficacy and safety of triple antiplatelet therapy with and without concomitant anticoagulation during elective percutaneous coronary intervention (the REMOVE trial).
- Source :
-
The American journal of cardiology [Am J Cardiol] 2007 Oct 01; Vol. 100 (7), pp. 1099-102. Date of Electronic Publication: 2007 Jul 18. - Publication Year :
- 2007
-
Abstract
- Adjunctive glycoprotein IIb/IIIa inhibition decreases ischemic events after percutaneous coronary intervention (PCI) but is associated with increased bleeding. We hypothesized that maximal antiplatelet therapy with aspirin, a thienopyridine, and a glycoprotein IIb/IIIa inhibitor without unfractionated heparin (UFH) would result in fewer bleeding complications and maintain efficacy in elective PCI. A total of 159 patients undergoing elective PCI were randomized to intraprocedural eptifibatide alone or eptifibatide plus UFH. Patients received aspirin 325 mg and clopidogrel 300 mg before the procedure. The primary end point was the Landefeld bleeding index. Secondary end points included the composite clinical outcome of in-hospital death, myocardial infarction, urgent target vessel revascularization, and Thrombolysis In Myocardial Infarction major bleeding, and a composite bleeding outcome of major, minor, and nuisance bleeding. The Landefeld bleeding index was significantly lower in the eptifibatide-only group compared with the eptifibatide-plus-UFH group (3.0 vs 3.9, p = 0.03). There was no significant difference in the composite clinical end point between groups (eptifibatide only 17% vs eptifibatide plus UFH 15%, p = 0.7). There was a trend toward a decrease in the composite bleeding end point in the eptifibatide-only compared with the eptifibatide-plus-UFH group (43% vs 56%, p = 0.10). In conclusion, during elective PCI, a strategy of aggressive antiplatelet therapy using aspirin, clopidogrel, and eptifibatide without anticoagulant therapy appears to decrease bleeding complications.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Aspirin therapeutic use
Clopidogrel
Coronary Artery Disease drug therapy
Drug Therapy, Combination
Eptifibatide
Female
Heparin therapeutic use
Humans
Male
Middle Aged
Peptides therapeutic use
Pilot Projects
Prospective Studies
Pyridines therapeutic use
Ticlopidine analogs & derivatives
Ticlopidine therapeutic use
Treatment Outcome
Angioplasty, Balloon, Coronary
Anticoagulants therapeutic use
Coronary Artery Disease therapy
Platelet Aggregation Inhibitors therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0002-9149
- Volume :
- 100
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 17884370
- Full Text :
- https://doi.org/10.1016/j.amjcard.2007.04.057