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Bivalirudin Versus Heparin During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

Hiten Patel1,2, Rana Garris2, Suchit Bhutani3

  • 1Department of Cardiology, Cape Fear Valley Medical Center, Campbell University, Fayetteville, NC, USA.

Cardiology Research
|October 23, 2019
PubMed

Insights

Bivalirudin and unfractionated heparin (UFH) show similar outcomes for acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI). Bivalirudin increased stent thrombosis, especially in ST-elevation myocardial infarction (STEMI), and its bleeding benefit was lost with provisional glycoprotein IIb/IIIa inhibitor use.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Comparing bivalirudin and unfractionated heparin (UFH) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).
  • Previous studies indicated bivalirudin had less bleeding but more stent thrombosis.
  • Evolving antiplatelet strategies may alter the comparative efficacy and safety profiles.

Purpose of the Study:

  • To compare the efficacy and safety of bivalirudin versus UFH in AMI patients undergoing PCI.
  • To evaluate the impact of modern adjunct antiplatelet strategies on outcomes.

Main Methods:

  • Meta-analysis of seven randomized controlled trials (RCTs) involving 22,844 patients.
  • Utilized Cochrane Review Manager (RevMan) 5.3 for data analysis.
  • Compared bivalirudin to UFH in patients with acute myocardial infarction requiring revascularization.

Main Results:

  • No significant difference in major adverse cardiac events (MACE) or cardiovascular mortality between bivalirudin and UFH.
  • Bivalirudin significantly increased acute stent thrombosis, particularly in ST-elevation myocardial infarction (STEMI) trials.
  • Bivalirudin reduced major bleeding, but this benefit was nullified when glycoprotein IIb/IIIa inhibitors (GPI) were used provisionally.

Conclusions:

  • Bivalirudin and UFH offer comparable MACE and cardiovascular mortality in AMI patients undergoing PCI.
  • Increased acute stent thrombosis with bivalirudin is a concern, especially in STEMI.
  • The bleeding advantage of bivalirudin is diminished with current provisional GPI use.
Abstract

Keywords:
BivalirudinHeparinPercutaneous coronary angiographySTEMI

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