In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention
Comparative study published in Am J Cardiol (2017)
Abstract
Randomized controlled trials have shown conflicting results regarding the outcome of bivalirudin in primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the in-hospital outcomes of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7,023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between January 2010 and December 2014. Patients were classified according to the peri-interventional anticoagulation regimen receiving heparin (n = 6430) or bivalirudin (n = 593) with or without GpIIb/IIIa inhibitors (GPIs). In-hospital mortality (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.57 to 2.25, p = 0.72), major adverse cardiovascular events (OR 1.18, 95% CI 0.65 to 2.14, p = 0.59), net adverse clinical events (OR 1.01, 95% CI 0.57 to 1.77, p = 0.99), and TIMI non-coronary artery bypass graft-related major bleeding (OR 0.41, 95% CI 0.09 to 1.86, p = 0.25) were not significantly different between the groups. However, we detected potential effect modifications of anticoagulants on mortality by GPIs (OR 0.12, 95% CI 0.01 to 1.07, p = 0.06) and access site (OR 0.25, 95% CI 0.06 to 1.03, p = 0.06) favoring bivalirudin in femoral access. In conclusion, this large real-world cohort of PPCI, heparin-based anticoagulation showed similar results of short-term mortality compared with bivalirudin. We observed a potential effect modification by additional GPI use and access favoring bivalirudin over heparin in femoral, but not radial, access.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
7,023 Austrian Acute PCI Registry patients; no significant differences between bivalirudin and heparin in mortality, MACE, or major bleeding; potential bivalirudin advantage in femoral access.
Why This Matters for Hirudotherapy
This registry study analyzed 7,023 consecutive patients from the Austrian Acute PCI Registry (January 2010–December 2014) comparing in-hospital outcomes of bivalirudin (n=593) versus heparin (n=6,430) during primary percutaneous coronary intervention. Bivalirudin is a synthetic direct thrombin inhibitor structurally derived from hirudin, the anticoagulant in medicinal leech saliva, so this study offers clinically relevant evidence on how a leech-secretome-inspired agent performs against standard heparin in a large real-world cohort. The study found no significant differences in in-hospital mortality, major adverse cardiovascular events, net adverse clinical events, or major bleeding between groups, but suggested potential effect modifications favoring bivalirudin with femoral access and concomitant GPI use. However, as a non-randomized registry analysis with a substantially smaller bivalirudin subgroup, it is susceptible to treatment-selection bias and confounding, and the subgroup observations warrant cautious interpretation.
Citation
In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention.
Hasun M et al. · Am J Cardiol, 2017
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