The most common anticoagulant used during
primary percutaneous coronary intervention is heparin. However, its effects can
be somewhat unpredictable, leading to higher-than-desirable rates of bleeding
and blood clots. Bivalirudin is a newer anticoagulant that has more predictable
“blood thinning” effects.
Bivalirudin is a safer and more effective
anticoagulant than heparin for treating patients with the most serious type of
heart attacks who undergo urgent percutaneous coronary intervention (PCI), and
can lower the risk of death or major bleeding by 31 percent finds a study, study
was a Late Breaking Clinical Trial presentation at the American Heart Association’s
Scientific Sessions (AHA 22) in Chicago, and published in The Lancet.
The study identifies the best and safest
treatment course for patients undergoing stenting to treat a STEMI heart
attack,compared with heparin, bivalirudin plus a short infusion substantially
improved the likelihood of surviving a STEMI and reduced the two most feared
complications-major bleeding and stent thrombosis.
In the “BRIGHT-4” trial, patients with
STEMI heart attacks underwent “primary PCI”-an emergency stenting procedure to
preserve heart muscle function. Patients require anticoagulant therapy during
this minimally invasive procedure to successfully open the blocked heart artery
and prevent future blood clots from forming and causing another heart attack.
This
new research evaluates the two most widely used regimens of heparin and
bivalirudin, which have never been directly compared with each other in an
adequately sized trial. Investigators followed patients for 30 days following
the procedure, the timeframe in which STEMI patients are at highest risk for
adverse events. Researchers found that 4.4 percent of patients treated with
heparin died or had a major bleed within 30 days, compared to 3.1 percent of
patients treated with bivalirudin. Overall, the bivalirudin group had a 31
percent reduction in the rate of death or major bleeding compared with patients
in the heparin group.
They found that deaths were reduced from
3.9 percent in heparin-treated patients to 3.0 percent in bivalirudin-treated
patients. Severe bleeding also was reduced from 0.8 percent in the heparin
group to 0.2 percent in the bivalirudin group.
Researchers concluded that the simple
decision to use bivalirudin during primary percutaneous coronary intervention
in patients with heart attacks, which is now generic and thus inexpensive, can
save hundreds of thousands of lives per year and prevent major bleeding and
stent thrombosis compared with heparin.
Reference:
Bivalirudin found to be safer
and more effective than heparin for treating heart attack patients undergoing
percutaneous coronary intervention; THE MOUNT SINAI HOSPITAL / MOUNT SINAI
SCHOOL OF MEDICINE; JOURNAL-The Lancet.