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Adjunctive treatments may reduce bleeding benefit of bivalirudin in PCI
In patients undergoing PCI, the use of transradial access, adjunctive glycoprotein IIb/IIIa inhibitors and potent P2Y12 inhibitors appears to diminish the bleeding disparities between bivalirudin and heparin without increasing the risk for stent thrombosis, according to recent findings.
The primary outcomes of the study were all-cause mortality, major hemorrhage, postprocedure or recurrent MI, definite stent thrombosis and ischemia-driven revascularization within 30 days after PCI.
The weighted mortality rate after the use of bivalirudin was 2.18 (95% CI, 1.81-2.66), which was equivalent to the weighted mortality rate of 2.34% after use of heparin. A traditional meta-analysis also supported no difference in survival between the two groups (OR = 0.93; 95% CI, 0.77-1.14). In randomized controlled trials in which bivalirudin was used with transradial access and planned glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors in most patients, no significant bleeding benefit of bivalirudin over heparin was observed (transradial access, OR = 0.89; 95% CI, 0.57-1.41; planned GPIIb/IIIa inhibitors, OR = 1.07; 95% CI, 0.87-1.31). Although the use of prasugrel (Effient, Daiichi Sankyo/Eli Lilly) or ticagrelor (Brilinta, AstraZeneca) diminished the bleeding differences (OR = 0.8; 95% CI, 0.63-1.03), these agents did not decrease stent thrombosis risk after bivalirudin (OR = 2.2; 95% CI, 1.48-3.27).
“The current analysis has found that heparin did not cause more bleeding than bivalirudin in [randomized controlled trials] when transradial access, newer P2Y12 agents or planned [GPIIb/IIIa inhibitors] were used with bivalirudin,” the researchers wrote. “When any of these three adjunctive therapies is selected during PCI, it seems reasonable in the absence of an increased bleeding risk in current practice to use heparin in place of bivalirudin to reduce the risk of [stent thrombosis].” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.