Efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access: A subgroup analysis from the bivalirudin in acute myocardial infarction versus heparin and GPI plus heparin trial
Randomized controlled trial published in Catheter Cardiovasc Interv (2016)
Abstract
OBJECTIVES: To explore the efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access. BACKGROUND: Bivalirudin reduces bleeding risks over heparin in patients undergoing PCI. However, bleeding advantages of bivalirudin in patients undergoing transradial intervention is uncertain. METHODS: In the BRIGHT trial, 1,723 patients underwent emergency PCI via radial access, with 576 patients in the bivalirudin arm, 576 in the heparin arm and 571 in the heparin plus tirofiban arm. The primary outcome was 30-day net adverse clinical event (NACE), defined as a composite of major cardiac and cerebral events or any bleeding. RESULTS: 30-day NACE occurred in 5.7% with bivalirudin, 7.8% with heparin alone (vs. bivalirudin, P = 0.159), and 10.3% with heparin plus tifofiban (vs. bivalirudin, P = 0.004). The 30-day bleeding rate was 0.9% for bivalirudin, 2.3% for heparin (vs. bivalirudin, P = 0.057), and 5.8% for heparin plus tirofiban (vs. bivalirudin, P < 0.001). Major cardiac and cerebral events (4.9 vs. 5.7 vs. 4.6%, P = 0.899), stent thrombosis (0.5 vs. 0.5 vs. 0.7%, P = 0.899) and acquired thrombocytopenia (0.2 vs. 0.5 vs. 0.9%, P = 0.257) at 30 days were similar among three arms. The interaction test for PCI access and randomized treatment showed no significance on all bleeding (P > 0.05). CONCLUSIONS: The bleeding benefit of bivalirudin was independent of artery access. Bivalirudin lead to statistical reduction on bleeding risks in comparison to heparin plus tirofiban, and only small numerical difference in comparison to heparin, with comparable risks of ischemic events and stent thrombosis in patients with acute myocardial infarction (AMI) undergoing emergency transradial PCI. © 2016 Wiley Periodicals, Inc.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
To explore the efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access.
Why This Matters for Hirudotherapy
The BRIGHT trial examined bivalirudin versus heparin or heparin plus tirofiban in 1,723 patients undergoing emergency percutaneous coronary intervention via radial access for acute myocardial infarction, with the primary outcome of 30-day net adverse clinical events (NACE). Bivalirudin showed a statistically significant reduction in 30-day bleeding compared with heparin plus tirofiban (0.9% vs. 5.8%, P < 0.001), while ischemic events, stent thrombosis, and thrombocytopenia were comparable across arms; the bleeding benefit was independent of artery access. The abstract provides no information about leeches, hirudotherapy, or any leech-derived compounds, and no defensible connection to ASH's domain can be drawn from this source. This study is solely a pharmacological comparison of anticoagulant regimens in interventional cardiology.
Citation
Efficiency and safety of bivalirudin in patients undergoing emergency percutaneous coronary intervention via radial access: A subgroup analysis from the bivalirudin in acute myocardial infarction versus heparin and GPI plus heparin trial.
Wang H et al. · Catheter Cardiovasc Interv, 2016
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