Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest
Randomized controlled trial published in Rev Esp Cardiol (Engl Ed) (2020)
Abstract
INTRODUCTION AND OBJECTIVES: Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited. We assessed outcomes of transradial vs transfemoral access and bivalirudin vs unfractionated heparin (UFH) in VP with acute coronary syndrome undergoing invasive management. METHODS: The MATRIX trial randomized 8404 patients to radial or femoral access and 7213 patients to bivalirudin or UFH. Among them, 934 (11.1%) were deemed VP due to advanced Killip class (n = 808), cardiac arrest (n = 168), or both (n = 42). The 30-day coprimary outcomes were major adverse cardiovascular and cerebrovascular events (MACE: death, myocardial infarction, or stroke) and net adverse clinical events (NACE: MACE or major bleeding). RESULTS: MACE and NACE were similarly reduced with radial vs femoral access in VP and non-VP. Transradial access was also associated with consistent relative benefits in all-cause and cardiovascular mortality or Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding with greater absolute benefits in VP. The effects of bivalirudin vs UFH on MACE and NACE were consistent in VP and non-VP. Bivalirudin was associated with lower all-cause and cardiovascular mortality in VP but not in non-VP, with borderline interaction testing. Bivalirudin reduced bleeding in both VP and non-VP with a larger absolute benefit in VP. CONCLUSIONS: In acute coronary syndrome patients undergoing invasive management, the effects of randomized treatments were consistent in VP and non-VP, but absolute risk reduction with radial access and bivalirudin were greater in VP, with a 5- to 10-fold lower number needed to treat for benefits. Trial registry number: NCT01433627.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Patients who are vulnerable to hemodynamic or electrical disorders (VP) are often excluded from clinical trials and data on the optimal access-site or antithrombotic treatment are limited.
Por qué esto importa para la hirudoterapia
Este análisis del ensayo MATRIX examinó los desenlaces del acceso transradial frente al transfemoral y de la bivalirudina frente a la heparina no fraccionada en 934 pacientes con síndrome coronario agudo con clase de Killip avanzada o parada cardiaca (designados como «pacientes vulnerables») de entre un total de 8.404 participantes. La bivalirudina se asoció con una menor mortalidad por todas las causas y cardiovascular en los pacientes vulnerables, y redujo el sangrado tanto en el grupo vulnerable como en el no vulnerable, con mayores beneficios absolutos en los pacientes vulnerables y un número necesario a tratar entre 5 y 10 veces menor. El resumen no aporta información alguna sobre sanguijuelas, hirudoterapia o compuestos derivados de sanguijuelas, y no puede establecerse ninguna conexión defendible con el ámbito de ASH a partir del resumen por sí solo. Se trata exclusivamente de un ensayo cardiológico sobre estrategias de acceso y anticoagulación.
Citación
Choice of access site and type of anticoagulant in acute coronary syndromes with advanced Killip class or out-of-hospital cardiac arrest.
Gargiulo G et al. · Rev Esp Cardiol (Engl Ed), 2020
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026