{"id":"ceb5a64d3289","type":"article","url":"https://hartvaat.nl/2019/02/26/postprocedurele-bivalirudine-infusie-bij-acs-vol-versus-laag-regime/","title":"Postprocedurele bivalirudine-infusie bij ACS: vol versus laag regime","title_en":"Post-Procedural Bivalirudin Infusion at Full or Low Regimen in Patients With Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.12.023","source_url":"https://doi.org/10.1016/j.jacc.2018.12.023","authors":["Giuseppe Gargiulo","Greta Carrara","Enrico Frigoli","Sergio Leonardi","Pascal Vranckx","Gianluca Campo","Ferdinando Varbella","Paolo Calabrò","Tiziana Zaro","Davide Bartolini","Carlo Briguori","Giuseppe Andò","Maurizio Ferrario","Ugo Limbruno","Salvatore Colangelo","Paolo Sganzerla","Filippo Russo","Marco Stefano Nazzaro","Giovanni Esposito","Giuseppe Ferrante","Andrea Santarelli","Gennaro Sardella","Stephan Windecker","Marco Valgimigli"],"significance":5,"published":"2019-02-26","source_date":"2019-02-26","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared full-dose versus low-dose post-procedural bivalirudin infusion after PCI in ACS patients, testing whether reduced post-procedural anticoagulation maintains efficacy with less bleeding.","created":"2026-07-03T10:27:47Z","updated":"2026-07-03T13:27:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van volledige versus verlaagde postprocedurele bivalirudine-infusie bij ACS-patiënten.","abstract_original":"BACKGROUND: The value of prolonged bivalirudin infusion after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients with or without ST-segment elevation remains unclear. OBJECTIVES: The purpose of this study was to assess efficacy and safety of a full or low post-PCI bivalirudin regimen in ACS patients with or without ST-segment elevation. METHODS: The MATRIX program assigned bivalirudin to patients without or with a post-PCI infusion at either a full (1.75 mg/kg/h for ≤4 h) or reduced (0.25 mg/kg/h for ≤6 h) regimen at the operator's discretion. The primary endpoint was the 30-day composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (composite of all-cause death, myocardial infarction, or stroke, or major bleeding). RESULTS: Among 3,610 patients assigned to bivalirudin, 1,799 were randomized to receive and 1,811 not to receive a post-PCI bivalirudin infusion. Post-PCI full bivalirudin was administered in 612 (ST-segment elevation myocardial infarction [STEMI], n = 399; non-ST-segment elevation acute coronary syndromes [NSTE-ACS], n = 213), whereas the low-dose regimen was administered in 1,068 (STEMI, n = 519; NSTE-ACS, n = 549) patients. The primary outcome did not differ in STEMI or NSTE-ACS patients who received or did not receive post-PCI bivalirudin. However, full compared with low bivalirudin regimen remained associated with a significant reduction of the primary endpoint after multivariable (rate ratio: 0.21; 95% CI: 0.12 to 0.35; p < 0.001) or propensity score (rate ratio: 0.16; 95% CI: 0.09 to 0.26; p < 0.001) adjustment. Full post-PCI bivalirudin was associated with improved outcomes consistently across ACS types compared with the no post-PCI infusion or heparin groups. CONCLUSIONS: In ACS patients with or without ST-segment elevation, the primary endpoint did not differ with or without post-PCI bivalirudin infusion but a post-PCI full dose was associated with improved outcomes when compared with no or low-dose post-PCI infusion or heparin (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627)."}