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Updated: Aug 10, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison of antithrombotic agents during urgent percutaneous coronary intervention following thrombolytic therapy:
Jaya R Mallidi1, Peter Robinson1, Paul F Visintainer2
1Division of Cardiology, Department of Internal Medicine, Baystate Medical Center, Tufts University, Springfield, MA, 01199.
Insights
Bivalirudin showed a trend toward fewer bleeding complications in ST-elevation myocardial infarction (STEMI) patients undergoing urgent percutaneous coronary intervention (PCI) after thrombolytic therapy. Further research is needed to determine the optimal antithrombotic regimen.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Optimal antithrombotic strategy for urgent percutaneous coronary intervention (PCI) post-thrombolytic therapy in ST-elevation myocardial infarction (STEMI) remains undefined.
- This study addresses the knowledge gap regarding anticoagulation choices in this specific patient population.
Purpose of the Study:
- To compare the efficacy and safety of bivalirudin, heparin alone, and heparin plus Glycoprotein IIb/IIIa inhibitor (GPI) in STEMI patients undergoing urgent PCI after thrombolysis.
- To evaluate major adverse cardiovascular events (MACE) and net adverse clinical events (NACE), including bleeding complications.
Main Methods:
- Retrospective analysis of 695 STEMI patients undergoing urgent PCI within 24 hours of thrombolytic therapy.
- Patients were stratified into three anticoagulation groups: bivalirudin, heparin alone, or heparin plus GPI.
- Outcomes (MACE and NACE) were compared using univariable, multivariable, and propensity-weighted analyses.
Main Results:
- No significant difference in MACE was observed across the three groups in univariable analysis.
- However, multivariable analysis revealed significantly higher odds of NACE (including major bleeding) with heparin alone (OR: 3.58) and heparin plus GPI (OR: 9.0) compared to bivalirudin.
- Bivalirudin demonstrated a trend toward reduced bleeding complications.
Conclusions:
- Bivalirudin use during urgent PCI in post-thrombolytic STEMI patients is associated with a trend toward fewer bleeding complications compared to heparin-based regimens.
- The findings suggest bivalirudin may be a safer option, but large randomized trials are warranted to confirm optimal antithrombotic therapy.
- Further investigation is crucial for this complex patient cohort.
Background:
The optimal antithrombotic regimen for urgent percutaneous coronary interventions (PCI) following thrombolytic therapy for ST segment myocardial infarction (STEMI) is currently unknown.
Methods:
We performed a retrospective analysis of all patients referred to our institution from January 2005 to July 2014 who underwent urgent PCI within 24 hr after receiving thrombolytic therapy. The patients were divided into three cohorts based on the anticoagulation strategy during PCI-bivalirudin, heparin alone or heparin plus Glycoprotein IIb/IIIa inhibitor (GPI). The primary end point of major adverse cardiovascular events (MACE) was defined as a composite of inpatient death, myocardial infarction (MI) and stroke. Net adverse clinical events (NACE) were defined as a combination of MACE plus major bleeding complications. Univariable, multivariable and propensity-weighted modeling were used to compare MACE and NACE between the three treatment groups.
Results:
A total of 695 patients met the inclusion criteria during the study period. In the univariable analysis, there was no significant difference treatment in MACE between the three groups (Bivalirudin: 1.2% vs. Heparin + GPI: 4.4%; Heparin alone: 2.7%, P = 0.11). In the reduced logistic regression model, compared to bivalirudin, the odds of NACE was significantly higher with heparin alone (OR: 3.58, 95% CI: 1.21, 10.54, P = 0.02) or with heparin plus GPI (OR: 9.0, 95% CI: 2.83, 28.64, P <0.001).
Conclusion:
In STEMI patients undergoing PCI within 24 hr after thrombolytic therapy, bivalirudin was associated with a strong trend toward reduced bleeding complications as compared to heparin alone or heparin plus GPI. The optimal antithrombotic regiment for urgent PCI following thrombolytic therapy is currently unknown. Our study demonstrated that use of bivalirudin during PCI following thrombolytic therapy is associated with a trend toward reduced bleeding complications compared to heparin alone or heparin plus GPI. Large randomized trials of adjunctive anticoagulation during PCI in this complex post-thrombolytic population are warranted. © 2017 Wiley Periodicals, Inc.
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