Bivalirudin bests heparin for treating heart attack patients undergoing PCI

Bivalirudin is a more beneficial anticoagulation treatment for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) than heparin, according to a new meta-analysis presented Wednesday, Oct. 14, at TCT Connect 2020.

Bivalirudin was linked to fewer serious bleeding events, the study’s authors reported. When looking exclusively at ST-segment elevation myocardial infarction (STEMI) patients, bivalirudin was also associated with reduced 30-day all-cause mortality, 30-day cardiac mortality and fewer net adverse clinical events.

The researchers explored data from more than 27,000 patients—more than 13,000 who were given bivalirudin and more than 14,000 who were given heparin. The cohort included more than 15,000 STEMI patients.

Overall, the team noted, the two medications had similar rates of 30-day mortality—1.9% for bivalirudin and 2.1% for heparin. When it came to serious bleeding events, however, the rates were 3.4% for bivalirudin and 5.7% for heparin.

“This individual patient data pooled analysis aimed to determine the optimal anticoagulant to be used during PCI in patients with AMI,” lead author Gregg W. Stone, MD, a professor of medicine at the Zena and Michael A. Wiener Cardiovascular Institute of the Icahn School of Medicine at Mount Sinai, said in a statement detailing the findings.

Stone did note that bivalirudin was linked to “increased rates of myocardial infarction and stent thrombosis compared to heparin,” but a high-dose infusion of bivalirudin following PCI “mitigated the MI and stent thrombosis risk.”

The study was funded by the Cardiovascular Research Foundation, the nonprofit organization behind TCTMD, and The Medicines Company.

More information on TCT Connect 2020 is available here.