BivaliRudin in Acute Myocardial Infarction vs Glycoprotein IIb/IIIa and Heparin :a Randomised Controlled Trial. (BRIGHT)
Acute Myocardial Infarction, Percutaneous Coronary Intervention
About this trial
This is an interventional treatment trial for Acute Myocardial Infarction focused on measuring Bivalirudin, Acute myocardial infarction, percutaneous transluminal coronary angioplasty
Eligibility Criteria
Inclusion Criteria:
- Age 18 to 80 years old
- Planned emergency PCI for acute myocardial infarction (STEMI or NSTEMI) Symptom onset within 12h for STEMI (or within 24 h for patients have unrelieved chest pain, continuous ST elevation or new developed LBBB) Symptom onset within 72h for NSTEMI
- Avoid to undergoing revascularization for non-culprit vessels within 30 days after index procedure.
- Provide written informed consent.
Exclusion Criteria:
- Unsuitable for PCI; treatment by thrombolysis within 72 hours of acute ST-elevation myocardial infarction; left main coronary artery disease; cardiogenic shock.
- Any anticoagulant agents were used 48 h before randomization.
- Active bleeding or bleeding constitution, bleeding tendency, including the recent retina or vitreous hemorrhage (1 months), GI or urinary tract hemorrhage (3 months), cerebral hemorrhage (6 months) or cerebral infarction history (3 months), etc.;
- Other disease may lead to vascular lesions and secondary bleeding factors (such as active gastric ulcer, active ulcerative colitis, intracranial aneurysm, etc.),
- Deep puncture or major surgery (including eye or brain surgery) within 1 month.
- Suspicious aortic dissection, pericarditis and subacute bacterial endocarditis.
- Untreated or uncontrolled hypertension > 180/110 mmHg.
- Hemoglobin < 100 g/L or platelet count < 100 * 109 / L.
- Elevated AST, ALT level higher than three times of the normal upper limit.
- severe renal insufficiency (eGFR < 30 mL/min / 1.73 m2).
- Heparin induced thrombocytopenia.
- Known allergy to the study drugs and instruments (UFH, bivalirudin, aspirin and clopidogrel, stainless steel, contrast agents, etc.), or those allergic constitution.
- Pregnancy or lactation.
- Researchers think that doesn't fit to participate in this study.
Sites / Locations
- 1 st Hosp. of Anhui Med Univ.
- Anhui Provincial Hosp.
- 3rd Hosp. of Beijing Univ.
- Beijing Anzhen Hosp.
- Beijing CAPF General Hosp.
- Beijing Chaoyang Hosp.
- Beijing Friendship Hosp.
- Beijing General Hosp. of PLA
- Beijing Hosp.
- Beijing Luhe Hosp.
- General Hosp of PLA (1)
- General Hosp. of PLA(2)
- Navy General Hosp. of PLA
- No.304 Hosp. of PLA
- No.306 Hosp. of PLA
- Peking Univ. First Hosp.
- The 2nd artillery general Hosp. of PLA
- Chongqing Daping Hosp.
- Fujian Med Univ. Uion Hosp.
- 1 st Hosp. of Lanzhou Univ.
- Lanzhou General Hosp. of PLA
- 1 st Hosp. of Guangzhou MU
- 1st Hosp. of Zhongshan MU
- Guangdong General Hosp.
- Guangzhou General Hosp. of PLA
- 1 st Hosp. of Guangxi Med Univ.
- No.252 Hosp. of PLA
- Cangzhou Centeral Hosp.
- Qinhuangdao No.1 Hosp.
- Hebei General Hosp.
- Shijiazhuang Peace Hosp.
- Tangshan Gongren Hosp.
- Daqing General Hosp. of OF.
- No.152 Hosp.
- Wuhan Asican Heart Hosp.
- Wuhan General Hosp of PLA
- Nanjing First Hosp.
- Xuzhou Med Col. Affiliated Hosp.
- Xuzhou No.4 Hosp.
- 2 nd Hosp. of Nanchang Univ.
- 1st Hosp of Jilin Univ.
- 2nd Hosp of Jilin Univ.
- 3rd Hosp of Jilin Univ.
- Meihekou Central Hosp.
- Dalian Zhongshan Hosp.
- No.210 Hosp of PLA
- No.313 Hosp. of PLA
- 1st Hosp. of Liaoning MC
- 3 rd Hosp. of Liaoning Med Col.
- No.463 Hosp of PLA
- Shenzhou Hosp. of SMC
- Yingkou Centeral Hosp.
- General Hosp. of Ningxia MU
- Ji'nan General Hosp. of PLA
- Affiliated Hosp. of Jining MC
- Taian Central Hosp.
- Yantaishan Hosp.
- No. 148 Hosp.
- Huashan Hosp.
- Shanghai jingan people's hosp.
- Shanghai Renji Hosp.
- 1st Hosp. of Shanxi Med Univ.
- Shanxi Cardiovascular Hosp.
- Taiyuan Central Hosp.
- 2 nd Hosp. of Xi'an Med Col.
- Shanxi General Hosp. of CAPF
- Shanxi General Hosp.
- Tangdu Hosp.
- Xijing Hosp.
- Yanan Univ. affiliated Hosp.
- Yuncheng Central Hosp.
- Chengdu General Hosp. of PLA
- Chengdu No.2 Hosp.
- No.254 Hosp. of PLA
- Tianjin CAPF Hosp.
- Tianjin Chest Hosp.
- Tianjin No.3 Hosp.
- Tianjin People's Hosp.
- Kunming General Hosp. of PLA
- 2nd Hosp. of Zhejiang Univ.
- Zhejiang Hosp.
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Active Comparator
Active Comparator
Bivalirudin
Heparin monotherapy
heparin plus tirofiban
Bivalirudin will be started in the cath lab, 0.75 mg/kg intravenous bolus followed by 1.75 mg/kg per h infusion; if ACT<225s 5min after bolus, an additional dose of 0.3mg/kg bolus should be given. After procedure, a prolonged infusion (1.75mg/kg per h) will be given for at least 30 min (totally no more than 4 h) followed by a reduced dose infusion (0.2mg/kg per h) up to 20 h.
100 IU/kg intravenous bolus. If ACT <225s 5 min after bolus injection, additional dose of heparin (20U/kg) will be given.
heparin 60 IU/kg intravenous bolus and Tirofiban: 10μg/kg intravenous bolus followed by 0.15μg/kg per min infusion for up to 36h.