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Safety of bivalirudin in percutaneous coronary intervention following thrombolytic therapy
Author(s) -
Sardi Gabriel L.,
Lindsay Joseph,
Waksman Ron
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24478
Subject(s) - medicine , bivalirudin , percutaneous coronary intervention , conventional pci , myocardial infarction , clopidogrel , cardiology , thrombolysis , heparin
Objectives This study was undertaken to evaluate the safety of bivalirudin (BIV) use during percutaneous coronary intervention (PCI), following thrombolytic therapy in patients with ST‐segment elevation myocardial infarction (STEMI). Background BIV has emerged as a safer anticoagulant than unfractionated heparin (UFH) during primary PCI; however, its use in patients who receive thrombolytic therapy has not been established. Methods A consecutive series of 104 patients who presented with STEMI treated with full‐dose thrombolytics and who subsequently received PCI within 6 hr was identified and analyzed. BIV use was compared with UFH for in‐hospital bleeding and ischemic events. The primary end points were the rate of major bleeding and the rate of net adverse clinical events as defined in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. The study cohort consisted of 104 patients, of whom 47 (45%) received BIV and 57 (55%) received UFH.Time distribution of patients receiving intraprocedural bivalirudin (BIV) or unfractionated heparin (UFH) after thrombolytic therapy. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]Results Patients on BIV were more frequently preloaded with clopidogrel, while intraprocedural glycoprotein IIb/IIIa inhibitors were used only in UFH patients. In‐hospital death, ischemic events, and thrombolysis in myocardial infarction major bleeding occurred more frequently in patients treated with UFH. The net adverse clinical events rate was lower in the intraprocedural BIV group (3 [6.4%] vs. 12 [21.1%] UFH, P = 0.034). Conclusions The use of BIV in patients presenting with STEMI who were pretreated with thrombolytic therapy and who subsequently underwent PCI is safe and is associated with less ischemic and bleeding events when compared with UFH, and should be considered as the first line anticoagulant for these patients during PCI. © 2012 Wiley Periodicals, Inc.