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Bivalirudin Improves Cardiac Outcomes for Diabetics

Diabetics with acute coronary syndromes have worse outcomes in general

TUESDAY, April 22 (HealthDay News) -- Diabetic patients with acute coronary syndromes have higher rates of adverse clinical outcomes than nondiabetics, and treatment with bivalirudin results in a lower rate of adverse outcomes than treatment with heparin plus glycoprotein IIb/IIIa inhibition (GPI), according to a study in the April 29 issue of the Journal of the American College of Cardiology.

Frederick Feit, M.D., FACC, of the New York University School of Medicine in New York and colleagues randomly assigned 13,819 patients with moderate- or high-risk acute coronary syndromes (27.9 percent of whom had diabetes mellitus) to receive heparin plus GPI, bivalirudin plus GPI or bivalirudin alone.

The researchers found that the diabetic patients overall had a significantly higher 30-day rate of net adverse clinical outcomes (12.9 for diabetics versus 10.6 percent for nondiabetics), consisting of death, myocardial infarction or unplanned ischemic revascularization (composite ischemia) or major bleeding. The rate of net adverse clinical outcomes in diabetic patients treated with bivalirudin plus GPI was similar to that of diabetic patients treated with heparin plus GPI, but the rate of net adverse clinical outcomes was significantly lower in those treated with bivalirudin alone.

"Compared with treatment with heparin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding, resulting in a significant reduction in net adverse clinical outcomes," the authors write.

The trial was sponsored by The Medicines Co. Several authors report financial ties to the pharmaceutical industry.

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