Evidence map›Paper›PMID 34699549›Full record

Trial reportPloS one2021

Reperfusion After Fibrinolytic Therapy (RAFT): An open-label, multi-centre, randomised controlled trial of bivalirudin versus heparin in rescue percutaneous coronary intervention.

Amir Faour, Nicholas Collins, Trent Williams, Arshad Khan, Craig P Juergens, Sidney Lo, Darren L Walters, Derek P Chew, John K French

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.3field-weighted citation impact, top 38% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 1 country.

Amir FaourDepartment of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.ORCID 0000-0002-4354-8899
Nicholas CollinsDepartment of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Trent WilliamsDepartment of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Arshad KhanDepartment of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Craig P JuergensDepartment of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
Sidney LoDepartment of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
Darren L WaltersUniversity of Queensland, Brisbane, Queensland, Australia.
Derek P ChewDepartment of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia.
John K FrenchDepartment of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
Liverpool Hospital · AUJohn Hunter Hospital · AUFlinders Medical Centre · AUThe University of Queensland · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe safety and efficacy profile of bivalirudin has not been examined in a randomised controlled trial of patients undergoing rescue PCI.

objectivesWe conducted an open-label, multi-centre, randomised controlled trial to compare bivalirudin with heparin ± glycoprotein IIb/IIIa inhibitors (GPIs) in patients undergoing rescue PCI.

methodsBetween 2010-2015, we randomly assigned 83 patients undergoing rescue PCI to bivalirudin (n = 42) or heparin ± GPIs (n = 41). The primary safety endpoint was any ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding at 90 days. The primary efficacy endpoint was infarct size measured by peak troponin levels as a multiple of the local upper reference limit (Tn/URL). Secondary endpoints included periprocedural change in haemoglobin adjusted for red cells transfused, TIMI (Thrombolysis in Myocardial Infarction) bleeding, ST-segment recovery and infarct size determined by the Selvester QRS score.

resultsThe trial was terminated due to slow recruitment and futility after an interim analysis of 83 patients. The primary safety endpoint occurred in 6 (14%) patients in the bivalirudin group (4.8% GPIs) and 3 (7.3%) in the heparin ± GPIs group (54% GPIs) (risk ratio, 1.95, 95% confidence interval [CI], 0.52-7.3, P = 0.48). Infarct size was similar between the two groups (mean Tn/URL, 730 [±675] for bivalirudin, versus 984 [±1585] for heparin ± GPIs, difference, 254, 95% CI, -283-794, P = 0.86). There was a smaller decrease in the periprocedural haemoglobin level with bivalirudin than heparin ± GPIs (-7.5% [±15] versus -14% [±17], difference, -6.5%, 95% CI, -0.83-14, P = 0.0067). The rate of complete (≥70%) ST-segment recovery post-PCI was higher in patients randomised to heparin ± GPIs compared with bivalirudin.

conclusionsWhether bivalirudin compared with heparin ± GPI reduces bleeding in rescue PCI could not be determined. Slow recruitment and futility in the context of lower-than-expected bleeding event rates led to the termination of this trial (ANZCTR.org.au, ACTRN12610000152022).

Indexed as

AgedAntithrombinsFemaleHeparinHirudinsHumansMaleMiddle AgedPeptide FragmentsPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsRecombinant ProteinsThrombolytic TherapyTreatment OutcomeAntithrombinsbivalirudinHeparinHirudinsPeptide FragmentsPlatelet Aggregation InhibitorsRecombinant Proteins

Identifiers

PMID34699549
PMCPMC8547635
OpenAlexW3209896641

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.