Frequency and safety of switching antithrombin therapy at a regional PCI center

The impact of switching antithrombin therapy in patients presenting with acute coronary syndromes (ACS) and undergoing percutaneous intervention (PCI) has varied in clinical trials. We sought to assess the incidence and safety of switching antithrombin therapy in ACS patients undergoing PCI at a regional medical center. All patients with ACS undergoing PCI (n = 728) during a specified time period in 2005 and 2007 were identified. Patients who were switched to the antithrombin bivalirudin were defined as the "switch" group (n = 323) and all others were defined as the "consistent" therapy group (n = 405). Primary endpoints were major adverse cardiac event (MACE) (death, MI or urgent revascularization), major bleeding and net adverse clinical event (NACE) (MACE or major bleeding). Multivariate analysis was performed to determine if switching antithrombotic therapy predicted primary outcomes. Among 728 patients undergoing PCI for ACS, 44% were switched to bivalirudin. Switch patient were more likely to be transfers from outside hospitals, older, female, and diabetic. Angiographic characteristics were similar in the two groups. Switch patients had a similar incidence of MACE (7 vs. 8%, P = 0.72), major bleeding (2 vs. 2%) and NACE (9 vs. 10%, P = 0.51) when compared to those who received consistent therapy. On multivariate analysis, switching did not predict MACE (OR = 0.94, 95% CI = 0.53-1.67, P = 0.84) or NACE (OR = 0.82, 95%CI = 0.48-1.41, P = 0.47). In a regional clinical practice of patients presenting with ACS and undergoing PCI, switching of antithrombin therapy to bivalirudin is a common practice and patient who are switched have similar outcomes compared to patients who receive consistent therapy.