Would you ask for bivalirudin in the ambulance on the way to the catheter lab for PCI?

 IfI had a heart attack I would have only the faintest idea what my options really were and what their relative harms and merits might be. Perhaps as I was sucking on my aspirin tablet, I might ask the paramedic to leave the blood pressure cuff inflated for about five minutes to achieve a bit of ischaemic preconditioning. I might call for a tot of cardioprotective brandy: they say it goes well with diamorphine. Has anyone done a trial of oral alcohol for acute MI? I suppose I would let the ambulance take me to the nearest catheter lab for PCI, although more than an hour might elapse before I even reached the hospital door. What should I accept on the way there? The Medicines Company hope that I would say bivalirudin. In the EUROMAX trial that they funded, 2218 people with AMI were randomised to either receive bivalirudin on the way to a PCI centre, or else a “optional receipt of a glycoprotein IIb/IIIa inhibitor.” A rather odd study design, made even odder by a change in the composite primary end-point after the trial had started. So compared with optional receipt of a glycoprotein IIb/IIIa inhibitor, and using thepost-commencement composite end-point of death or major bleeding not associated with coronary-artery bypass grafting (CABG), “Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis.” Is that clear t...
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums