BRIGHT-4 Trial — Bivalirudin vs Heparin by BMI

Prespecified subgroup analysis of the BRIGHT-4 randomized trial comparing bivalirudin (a synthetic analogue of leech hirudin) followed by a 2-4 h high-dose post-PCI infusion with heparin monotherapy in 6,016 randomized STEMI patients undergoing primary PCI, stratified by baseline BMI (3,284 patients, 54.6%, had BMI < 25 kg/m2). Bivalirudin reduced the 30-day composite of all-cause death or BARC 3-5 bleeding versus heparin in patients with BMI < 25 kg/m2 (3.2% vs 5.7%; adjusted HR 0.56, 95% CI 0.40-0.79) but not in those with BMI >= 25 kg/m2 (2.9% vs 2.9%; adjusted HR 0.97, 95% CI 0.62-1.52; P interaction = 0.04).

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