Bivalirudin linked to reduced bleeding complications after PCI
MedWire News:A bivalirudin-based anticoagulation strategy is associated with a significantly reduced risk for acute and long-term bleeding complications compared with an unfractionated heparin (UFH) strategy among patients undergoing percutaneous coronary intervention (PCI), US researchers report.
This finding is important because "multiple studies have reported a strong association between bleeding complications and mortality after PCI," remark Frederic Resnic (Harvard Medical School, Boston, Massachusetts) and colleagues.
In their study of 3367 consecutive patients who underwent PCI for stable angina or non-ST-segment elevation acute coronary syndrome, the researchers compared the risks for bleeding and major adverse cardiac events (MACE) associated with bivalirudin- and UFH-based anticoagulation strategies.
In all, 2228 (66%) patients received UFH and 1139 (34%) received bivalirudin.
The team found that patients who received bivalirudin-based anticoagulation had significantly fewer bleeding complications than those on UFH both at 30 days (7.0% vs 13.7%, respectively) and 1 year (12.7% vs 18.9%).
Furthermore the rates of MACE (death, recurrent myocardial infarction [MI], or repeat revascularization) did not differ significantly between the groups. At 30 days, the MACE rate was 10.9% in the bivalirudin group compared with 9.4% in the UFH group, and at 1 year the respective rates were 14.8% and 12.1%.
Similarly, there was no difference in all-cause mortality rates between the bivalirudin and UFH groups at either 30 days, at 1.9% versus 3.6%, respectively, or 1 year, at 3.6% versus 5.5%.
Writing in the American Journal of Cardiology, Resnic and co-authors say that their findings "validate the durable efficacy of bivalirudin in routine clinical practice."
They note that the data cannot be extrapolated to patient groups excluded from the study, principally those undergoing primary PCI for acute MI or those with total occlusion.
"Despite exclusion of these patients, 30-day and 1-year MACE rates in our study were similar to those in other recent PCI trials," the team concludes.
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By Laura Dean