Bertrand OF 201111

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Early Discharge after Transradial Stenting of Coronary Arteries: Bivalirudin to Reduce Bleeding (The EASY-B2B Trial)

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Bertrand OF 201111

  1. 1. EArly Discharge after Transradial Stenting of CoronarY Arteries: Bivalirudin to Reduce Bleeding- The EASY-B2B TrialOlivier F. Bertrand, MD, PhDAssociate-Professor of Medicine, Laval UniversityAdjunct-Professor, Department of Mechanical Engineering, McGill UniversityQuebec Heart-Lung Institute TCT-2011
  2. 2. DisclosuresResearch grants: Cordis, Eli-Lilly, Bristol-Myers-Squibb, GE Healthcare, Sanofi-Aventis, EurocorConsultant: Cordis, Astra-Zeneca, OpsensResearch-Scholar from Quebec Foundation forHealth ResearchFunding: QHLI Foundation, Laval UniversityTransradial Research & Education Fund
  3. 3. 89%
  4. 4. Verheugt JACC Cardio Interv 2011;4:191-7
  5. 5. Verheugt JACC Cardio Interv 2011;4:191-7
  6. 6. EXCLUSION- PPCI- RECENT BLEED- CREAT CL < 30 ML/MIN- PLT < 70.000- CHRONIC AC G PATTI ET AL. ACC 2011
  7. 7. ANTITHROMBOTIC REGIMENS AND RESIDUAL BLEEDING RISK HAMON ET AL. EUROINTERVENTION, 2009
  8. 8. ObjectiveIn patients at high risk ofbleeding and undergoingtransradial PCI, bivalirudinhas a better safety/efficacyprofile compared to heparin
  9. 9. EASY B2B-DesignPatients at high risk of non-access site bleeding: ≥2 risk-factors: Age > 70, female, CKD, recent GI ororgan bleeding, anemia, diabetes, prior GPI/Tnk. ≃ 2500 Transradial PCI BAIL-OUT GPI HEPARIN BIVALIRUDIN 1ST END-POINT: DEATH, MI, URGENT REVASCULARIZATION, BARC BLEEDING 2,3,5 AT 30 DAYS FU
  10. 10. Results: Population Characteristics Age (years) 77 ± 9 Weight (kg) 73 ± 16 Previous MI 29% Previous PCI 29% Previous CABG 11% Stable Angina 10% Unstable Angina 46% NSTEMI 38% STEMI 7% Antithrombotic Rx upon arrival - heparin (iv) . - LMWH . 44% - Fondaparinux. 22% - Tnk/GPI 6% 5.8%
  11. 11. Results: Population Characteristics
  12. 12. Results: Population Characteristics
  13. 13. OF BERTRAND-QC, CANADA T MANN-RALEIGH, NC, US
  14. 14. Conclusion:Residual bleeding risk remains a serious issueBleedings risks non-associated with PCIprocedures are frequentStrategies to reduce residual bleeding riskremains to be definedBenefit of bivalirudin-monotherapy comparedto heparin-monotherapy in patients at highresidual bleeding risk remains to bedemonstrated

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