Bivalirudin vs. Heparin Following PCI in STEMI Patients

No significant difference in rate of composite end point of death, myocardial infarction, or stroke
No significant difference in rate of composite end point of death, myocardial infarction, or stroke

HealthDay News — Similar outcomes are seen for use of bivalirudin and heparin as anticoagulant agents in patients with ST-segment elevation myocardial infarction (STEMI) treated with radial primary percutaneous coronary intervention (PCI), according to a study published online May 17 in JACC: Cardiovascular Interventions.

Ion S. Jovin, MD, ScD, from Virginia Commonwealth University in Richmond, and colleagues compared outcomes for patients with STEMI who underwent primary PCI via radial access and received bivalirudin or heparin as anticoagulation agents (29,660 and 37,708 patients, respectively).

The researchers observed no significant difference in the rate of the composite end point of death, myocardial infarction, or stroke in the unadjusted comparison (4.6 versus 4.7%; P=0.47). The rate of acute stent thrombosis was significantly higher with bivalirudin versus heparin (1.00 versus 0.6%; P<0.001). The odds ratio for the composite end point of death, myocardial infarction, or stroke was 0.95 (95% confidence interval, 0.87 to 1.05; P=0.152) for bivalirudin versus heparin, after adjustment for multiple variables, including for a propensity score; the odds ratio for acute stent thrombosis was 2.11 (95% confidence interval, 1.73 to 2.57; P<0.001). There was no significant difference noted in major bleeding rates. 

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"In patients undergoing primary PCI via transradial access anticoagulated with bivalirudin or heparin, there was no difference in the composite end point of death, myocardial infarction, or stroke," the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical device industries.

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