#16
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Уважаемые модераторы, предлагаю устроить опрос: "Нужно ли использовать при коронарных ангиопластиках бивалирудин, если вы работаете через лучевой доступ с гепарином в дозе 70 ед/кг без ИГПР?"
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#17
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Должна же быть какая-то альтернатива гепарину для пациентов с гепарин-индуцированной тромбоцитопенией или для тех, у кого большой риск ее развития.
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Искренне, Вадим Валерьевич. |
#18
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Цитата:
The study was supported by unrestricted grants from the Medicines Company and AstraZeneca.
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С уважением |
#19
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Хорошо. Давайте так: "Нужно ли использовать при коронарных ангиопластиках бивалирудин, если вы работаете через лучевой доступ с гепарином в дозе 70 ед/кг с селективным использованием ИГПР у пациентов без риска ГИТ?"
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#20
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Господа, а разве на просторах нашей необъятной родины и в ее окрестностях кто-то не знает проф. Абугова, требую провести голосование.
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#21
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FYI
Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction doi: 10.1093/eurheartj/ehu182 First published online: May 9, 2014 Цитата:
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#22
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Наверное, уже все читали про MATRIX Antithrombin? [Ссылки доступны только зарегистрированным пользователям ]
- randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin. Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion. - The rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (10.3% and 10.9%, respectively; relative risk, 0.94; 95% confidence interval [CI], 0.81 to 1.09; P = 0.44), nor was the rate of net adverse clinical events (11.2% and 12.4%, respectively; relative risk, 0.89; 95% CI, 0.78 to 1.03; P = 0.12). Post-PCI bivalirudin infusion, as compared with no infusion, did not significantly decrease the rate of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (11.0% and 11.9%, respectively; relative risk, 0.91; 95% CI, 0.74 to 1.11; P = 0.34). - the sponsor and funders had no role in the design of the study, the collection, monitoring, analysis, and interpretation of the data, or the writing of the report. |
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#23
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В предыдущих публикациях указание на непричастность спонсоров отсутствовало!
Алексей Геннадьевич, крепко Вас зацепил гастролер из столичной известной клиники!) |
#24
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на мой взгляд, все тонкости/промахи обсуждаются в ред. комментарии
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Искренне, Вадим Валерьевич. |
#25
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На недавнем ТСТ в Вашингтоне обсуждали бивалирудин и гепарин при ОКС.
Опрос участников - см. картинку. И еще готовится к выходу в Am J Cardiol большой метаанализ "Meta-Analysis of Effects of Bivalirudin Versus Heparin on Myocardial Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention". Выводы: Bivalirudin is an alternative to unfractionated heparin (UFH) anticoagulation during percutaneous coronary intervention. Previously, we have reported clinical benefit on major bleeding in favor of bivalirudin compared with UFH monotherapy but inconclusive results on mortality. Controversial data have been reported in the last 2 years. We conducted an updated meta-analysis including randomized trials and observational studies, which evaluated ischemic and bleeding outcomes for bivalirudin compared with UFH-only during percutaneous coronary intervention. We included 18 observational studies and 12 randomized trials published from 2003 to 2015. Primary outcomes were major adverse cardiovascular events within 30 days including death, myocardial infarction, and urgent revascularization and stent thrombosis, major bleeding, and transfusion. Overall, we found a significant risk reduction with bivalirudin for major bleeding (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.49 to 0.71, p <0.0001) and for transfusion (OR 0.79, 95% CI 0.66 to 0.95, p [ 0.01) and similar risk for major adverse cardiovascular events (OR 0.98, 95% CI 0.86 to 1.12, p [ 0.80). However, there was a substantial increased risk of stent thrombosis associated with bivalirudin (OR 1.52, 95% CI 1.11 to 2.08, p [ 0.009). No impact on mortality was found. Meta-regression analyses on major bleeding suggested that bivalirudin was more effective than UFH at doses >60 IU/kg and independent of radial access. In conclusion, compared with UFH monotherapy, bivalirudin remains associated with less bleeding risk but higher stent thrombosis risk. Further study remains required to define its role in current antithrombotic armamentarium. Цена ангиокса 250мг №10 для нашей больницы 326 750 руб Цена гепарина BBRAUN 25000 №10 1190 руб. |