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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este estudio de registro analizó 7.023 pacientes consecutivos del Austrian Acute PCI Registry (enero de 2010–diciembre de 2014), comparando los desenlaces hospitalarios de bivalirudina (n=593) frente a heparina (n=6.430) durante la intervención coronaria percutánea primaria. La bivalirudina es un inhibidor directo de la trombina sintético derivado estructuralmente de la hirudina, el anticoagulante presente en la saliva de la sanguijuela medicinal, por lo que este estudio aporta evidencia clínicamente relevante sobre el desempeño de un agente inspirado en el secretoma de la sanguijuela frente a la heparina estándar en una cohorte grande del mundo real. El estudio no halló diferencias significativas en mortalidad hospitalaria, eventos cardiovasculares adversos mayores, eventos clínicos adversos netos ni sangrado mayor entre los grupos, pero sugirió posibles modificaciones del efecto a favor de la bivalirudina con acceso femoral y uso concomitante de inhibidores de la glicoproteína IIb/IIIa. Sin embargo, por tratarse de un análisis de registro no aleatorizado con un subgrupo de bivalirudina sustancialmente menor, es susceptible a sesgo de selección de tratamiento y confusión, y las observaciones de subgrupos merecen interpretación cautelosa.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026