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Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction.
J Invasive Cardiol 2019; 31(12):E387-E391JI

Abstract

BACKGROUND

A pharmacoinvasive strategy for ST-segment elevation myocardial infarction (STEMI) management combines the use of fibrinolysis with the routine transfer to coronary angiography, with percutaneous coronary intervention (PCI) if needed. This method reduces the risk of major adverse cardiovascular event (MACE) compared with fibrinolysis alone; however, it is associated with higher bleeding risk. We sought to assess the bivalirudin compared with unfractionated heparin (UFH) used during PCI as part of a pharmacoinvasive strategy.

METHODS

We identified consecutive patients referred to the University of Ottawa Heart Institute between April 2009 and May 2011 as part of a pharmacoinvasive strategy for STEMI. The primary efficacy outcome was MACE, defined as a composite of death, reinfarction, or stroke during index hospitalization. The primary safety outcome was TIMI bleeding.

RESULTS

We identified 200 patients meeting inclusion criteria: 123 patients (61.5%) in the bivalirudin group and 77 patients (37.5%) in the UFH group. Median fibrinolysis to balloon time was 324 minutes in the bivalirudin group and 226 minutes in the UFH group (P<.001). Initial TIMI grade 3 flow was higher in the bivalirudin group vs the UFH group, but there was no difference in the rates post PCI. MACE rates were 4.9% vs 7.8% (P=.40) and TIMI bleeding rates were 7.3% vs 11.7% (P=.29) in patients treated with bivalirudin vs UFH, respectively.

CONCLUSION

The periprocedural use of bivalirudin vs UFH was associated with similar rates of MACE and bleeding. Given the expense of bivalirudin and lack of demonstrable clinical superiority, UFH remains the first-line periprocedural anticoagulant in a pharmacoinvasive strategy.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableUniversity of Ottawa Heart Institute, 40 Ruskin street, Ottawa, Ontario K1Y 4W7, Canada. mlemay@ottawaheart.ca.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31786531

Citation

Rashid, Mohammed K., et al. "Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction." The Journal of Invasive Cardiology, vol. 31, no. 12, 2019, pp. E387-E391.
Rashid MK, Singh K, Bernick J, et al. Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction. J Invasive Cardiol. 2019;31(12):E387-E391.
Rashid, M. K., Singh, K., Bernick, J., Wells, G. A., Hibbert, B., Russo, J., ... Le May, M. R. (2019). Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction. The Journal of Invasive Cardiology, 31(12), pp. E387-E391.
Rashid MK, et al. Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction. J Invasive Cardiol. 2019;31(12):E387-E391. PubMed PMID: 31786531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Periprocedural Bivalirudin Versus Unfractionated Heparin During Percutaneous Coronary Intervention Following Fibrinolysis for ST-Segment Elevation Myocardial Infarction. AU - Rashid,Mohammed K, AU - Singh,Kuljit, AU - Bernick,Jordan, AU - Wells,George A, AU - Hibbert,Benjamin, AU - Russo,Juan, AU - So,Derek Y, AU - Le May,Michel R, AU - ,, PY - 2019/12/2/entrez PY - 2019/12/2/pubmed PY - 2019/12/2/medline KW - PCI post fibrinolysis KW - acute myocardial infarction KW - periprocedural anticoagulation SP - E387 EP - E391 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 31 IS - 12 N2 - BACKGROUND: A pharmacoinvasive strategy for ST-segment elevation myocardial infarction (STEMI) management combines the use of fibrinolysis with the routine transfer to coronary angiography, with percutaneous coronary intervention (PCI) if needed. This method reduces the risk of major adverse cardiovascular event (MACE) compared with fibrinolysis alone; however, it is associated with higher bleeding risk. We sought to assess the bivalirudin compared with unfractionated heparin (UFH) used during PCI as part of a pharmacoinvasive strategy. METHODS: We identified consecutive patients referred to the University of Ottawa Heart Institute between April 2009 and May 2011 as part of a pharmacoinvasive strategy for STEMI. The primary efficacy outcome was MACE, defined as a composite of death, reinfarction, or stroke during index hospitalization. The primary safety outcome was TIMI bleeding. RESULTS: We identified 200 patients meeting inclusion criteria: 123 patients (61.5%) in the bivalirudin group and 77 patients (37.5%) in the UFH group. Median fibrinolysis to balloon time was 324 minutes in the bivalirudin group and 226 minutes in the UFH group (P<.001). Initial TIMI grade 3 flow was higher in the bivalirudin group vs the UFH group, but there was no difference in the rates post PCI. MACE rates were 4.9% vs 7.8% (P=.40) and TIMI bleeding rates were 7.3% vs 11.7% (P=.29) in patients treated with bivalirudin vs UFH, respectively. CONCLUSION: The periprocedural use of bivalirudin vs UFH was associated with similar rates of MACE and bleeding. Given the expense of bivalirudin and lack of demonstrable clinical superiority, UFH remains the first-line periprocedural anticoagulant in a pharmacoinvasive strategy. SN - 1557-2501 UR - https://www.unboundmedicine.com/medline/citation/31786531/Periprocedural_Bivalirudin_Versus_Unfractionated_Heparin_During_Percutaneous_Coronary_Intervention_Following_Fibrinolysis_for_ST-Segment_Elevation_Myocardial_Infarction L2 - https://www.invasivecardiology.com/articles/periprocedural-bivalirudin-versus-unfractionated-heparin-during-percutaneous-coronary-intervention-following-fibrinolysis-st-segment-elevation-myocardial-infarction DB - PRIME DP - Unbound Medicine ER -