#1
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Áèâàëèðóäèí - ýòî èíòåðåñíî ;)
HEAT-PPCI Outcomes
Outcome Bivalirudin (%) Heparin (%) RR (95% CI) p MACE 8.7 5.7 1.52 (1.1–2.1) 0.01 Definite or probable stent thrombosis 3.4 0.9 3.91 (1.6–9.5) 0.001 Major bleeding 3.5 3.1. — NS Ïðèçíàþ, ÷òî èìåþ ïî ýòîìó ïîâîäó êîíôëèêò èíòåðåñîâ, òàê êàê ÿâëÿþñü êîíñóëüòàíòîì/ëåêòîðîì ïî èíòåãðèëèíó. Íî, ñîãëàñèòåñü, êîëëåãè, îðèãèíàëüíûå ðåçóëüòàòû, à? Îñîáåííî â êîíòåêñòå âñåãî îïóáëèêîâàííîãî ðàíåå ![]() Ïîäðîáíåå - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#2
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î÷åíü èíòåðåñíûå äàííûå
Íî ýòî æå îäíîöåíòðîâîå èññëåäîâàíèå. Êàê ÿ ïîíÿë áèâàëèðóäèí íàçíà÷àëñÿ òîëüêî âî âðåìÿ ÷êâ áåç äàëüíåéøåé èíôóçèè.
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#3
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åùå ÷èñòî ìåõàíèñòè÷åñêè: â òðàéëå ISAR-REACT 3 áèâàëèðóäèí ñðàâíèâàëñÿ ñ ãåïàðèíîì è îáà ïðåïàðàòà äàëè îäèíàêîâûé äîâîëüíî âûñîêèé %, ñðàâíèìûé ñ ÷àñòîòîé, ïîëó÷åííîì íà áè- â ýòîì òðàéëå - (8.3% versus 8.7%), íî áîëåå âûñîêèé ðèñê áî-êðîâîòå÷åíèé íà ãåïàðèíå: (3.1% versus 4.6%), â íåì ãåïàðèí äàâàëñÿ â äîçå 140ÅÄ/êã, â HEAT PPCI ãåïàðèí äàâàëñÿ â äîçå 70 ÅÄ/êä è êàê èòîã - ìåíüøå êðîâîòå÷åíèé (3.1%) è ìåíüøå êîíå÷íûõ òî÷åê äðóãèõ (â îðèãèíàëüíîé ñëàéä ïðåçåíòàöèè - ðèñê áî-êðîâîòå÷åíèé àññîöèèðîâàëñÿ ñ áîëüøèì % ðàçâèòèÿ îñëîæíåíèé). Òåïåðü îñòàëîñü âûÿñíèòü - åñëè è áèâàëè- äàâàòü â ìåíüøåé äîçå, òî íå áóäåò ëè è îí ëó÷øå/áåçîïàñíåå ðàáîòàòü (êàê ïîêàçàëè äëÿ íåÔÃ)?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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Ýòî îäíîöåíòðîâîå èññëåäîâàíèå, ÷òî ÍÅÑÎÌÍÅÍÍÎ ñíèæàåò åãî çíà÷èìîñòü ñ òî÷êè çðåíèÿ ÅÂÌ. Íî âåäü ïî÷òè 2000 ïàöèåíòîâ! È â èññëåäîâàíèè, êîòîðîå íå ñïîíñèðîâàëîñü íèêàêèìè ïðîèçâîäèòåëÿìè, ÷òî òîæå, íà ìîé âçãëÿä, íåìàëîâàæíî.
Ðåæèì äîçèðîâàíèÿ áèâàëèðóäèíà òàì áûë ðîâíî òàêîé, êàê ïðîïèñàíî â èíñòðóêöèè. Íèêàêîé ñàìîäåÿòåëüíîñòè. |
#5
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![]() Íàñêîëüêî ìíå èçâåñòíî, â ñïîíñîðàõ çíà÷èëàñü àñòðà çåíåêà (áðèëèíòà). Ìîãëî ëè ýòî ïîâëèÿòü íà ðåçóëüòàòû? Íå èìåþ äîñòóïà ê ïîëíîìó òåêñòó ñòàòüè. Ìíîãî âîïðîñîâ...
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#6
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ß áû òîæå ñ óäîâîëüñòâèåì ïî÷èòàëà ïîëíûé òåêñò. Ïîêà äîñòóïíî òîëüêî îáñóæäåíèå äîêëàäà (ññûëêà âûøå).
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#7
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Öèòàòà:
The study was supported by unrestricted grants from the Medicines Company and AstraZeneca.
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Ñ óâàæåíèåì |
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#8
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ïîïðîáóþ åùå ðàçîê äîíåñòè ñâîþ ìûñëü: íå áèâàëèðóäèí îêàçàëñÿ õóæå, à ãåïàðèí 70 ÅÄ/êã îêàçàëñÿ ëó÷øå è áåçîïàñíåå, ÷åì ãåïàðèí 140ÅÄ/êã êàê áûëî â ISAR-REACT 3.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Âàäèì Âàëåðüåâè÷, äåëî â òîì, ÷òî ÑÒÀÍÄÀÐÒÍÛÉ ðåæèì äîçèðîâàíèÿ ãåïàðèíà - êàê ðàç 70 ÌÅ/êã. Ò.å., ïðè ñòàíäàðòíîì ðåæèìå ïîëó÷àåòñÿ, ÷òî ãåïàðèí ëó÷øå áèâàëèðóäèíà (â ýòîì êîíêðåòíîì èññëåäîâàíèè).
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#10
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Ìîé êîíôëèêò èíòåðåñîâ ìîæíî óìåñòèòü òîëüêî â Ãðàíä Êàíüîíå. Êñòàòè, ïàôîñíûì ëåêòîðîì èç Ìîñêâû, êîòîðûé íå ïîíðàâèëñÿ ˸øå, âïîëíå ìîã áû áûòü ÿ. Çàäàì ôèëîñîôñêèé âîïðîñ: ïðè íàëè÷èè ïðîòèâîðå÷èâûõ äàííûõ â ðàçëè÷íûõ èññëåäîâàíèÿõ, êàêîìó èç íèõ ìû äîëæíû âåðèòü? Âíå ñâÿçè ñ îáñóæäàåìîé òåìîé.
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Àáóãîâ Ñåðãåé Àëåêñàíäðîâè÷. Ðîññèéñêèé Íàó÷íûé Öåíòð Õèðóðãèè èì. àêàäåìèêà Á.Â. Ïåòðîâñêîãî. |
#11
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#12
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Öèòàòà:
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#13
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Àííà Åâãåíüåâíà, à âîò ñ ýòîãî ìîìåíòà õîòåëîñü áû êîíêðåòèêè - ãäå ñòàíäàðòíûé ðåæèì ãåïàðèíà 70ÅÄ/êã ñðàâíèâàëñÿ ñî ñòàíäàðòíûì áèâàëèðóäèíà äî ýòîãî è ê ãåïàðèíó äîâåñêîì íå øëè áû GPI???
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#14
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Öèòàòà:
"Propensity score-adjusted analysis confirmed that in-hospital major bleeds occurred less frequently with bivalirudin compared with GPIs (OR 2.96; 95% CI 1.60-5.45; P < 0.001) but not compared with heparin alone (OR 1.21; 95% CI 0.60-2.43; P = 0.58). Notably, propensity score adjustment demonstrated that the composite outcome occurred less frequently with bivalirudin compared with GPI and heparin combined (OR 1.62; 95% CI 1.07-2.44; P = 0.02). However, as with the primary endpoint, no difference was observed when bivalirudin was compared with heparin alone (OR 1.05; 95% CI 0.68-1.63; P = 0.83)." Òîæå ãåïàðèí íà âûñîòå. ß íå íàøåë äîçó ãåïàðèíà â êàòëàáå, âåðîÿòíî íà óñìîòðåíèå ñïåöèàëèñòîâ. |
#15
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Meta-Analysis Comparing Bivalirudin Versus Heparin Monotherapy on Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention
Bertrand, Olivier F., MD, PhD, Jolly, Sanjit S., MD, MSc, Rao, Sunil V., MD, Patel, Tejas, MD, Belle, Loic, MD, Bernat, Ivo, MD, Parodi, Guido, PhD, Costerousse, Olivier, PhD, Mann, Tift, MD American Journal of Cardiology, The, 2012-08-15 , Volume 110, Issue 4, Pages 599-606 "The main findings from this systematic review and metaanalysis from 16 studies involving 32,492 patients under- going transfemoral PCI are that bivalirudin compared to UFH monotherapy is associated with a similar risk of MACEs and a 45% relative decrease in major bleeding. Although bivalirudin was associated with a significant decrease in mortality in observational studies, this effect remained inconclusive in randomized trials. In observational and randomized studies, bivalirudin was associated with a similar rate of MI compared to UFH." "The radial approach to PCI is associated with a significantly lower rate of bleeding compared to the femoral approach and its main effect appears to be due to almost complete abolition of access-site bleeding. In recent trials, nonaccess-site bleeding represented 2/3 of the bleeding." "We found that almost all observational studies have been performed in the United States, whereas all randomized trials have been performed in Europe. Given significant international differences in practice patterns, particularly as they relate to the current use of radial approach, there is a need for a large international randomized trial comparing bivalirudin to UFH monotherapy." À â HEAT PPCI êàê ðàç î÷åíü âûñîêèé ïðîöåíò ëó÷åâîãî äîñòóïà â îáåèõ ãðóïïàõ. |