Heparin vs. Bivalirudin in Primary PCI
(HealthDay News) — For patients undergoing emergency angiography in the context of primary percutaneous coronary intervention (PPCI), use of unfractionated heparin is associated with a reduction in major adverse ischemic events vs. bivalirudin, with no increase in major bleeding, according to a study published online July 5 in The Lancet.
Adeel Shahzad, MBBS, from the Liverpool Heart and Chest Hospital NHS Foundation Trust in the United Kingdom, and colleagues compared antithrombotic therapy with bivalirudin or unfractionated heparin during PPCI. A total of 1,812 patients undergoing emergency angiography in the context of PPCI were randomized to heparin or bivalirudin, and were followed for 28 days.
Overall, 83% of patients in the bivalirudin group and 82% in the heparin group underwent PCI. The researchers found that the rate of glycoprotein IIb/IIIa inhibitor use was similar between the groups (13% in the bivalirudin group vs. 15% in the heparin group). The primary efficacy outcome of a composite of all-cause mortality, cerebrovascular accident, reinfarction, or unplanned target lesion revascularization occurred in 8.7 and 5.7%, respectively (P=0.01). The primary safety outcome of incidence of major bleeding occurred in 3.5 and 3.1%, respectively (P=0.59).
"Compared with bivalirudin, heparin reduces the incidence of major adverse ischemic events in the setting of PPCI, with no increase in bleeding complications," the authors write.
One author disclosed financial ties to The Medicines Company and AstraZeneca, which partially funded the study.