In-hospital outcomes after switching from a bivalirudin-first strategy to an unfractionated heparin-first strategy for percutaneous coronary interventions
Research article published in Cardiovascular diagnosis and therapy (2018)
Abstract
BACKGROUND: The optimal anticoagulation strategy for percutaneous coronary interventions (PCIs) remains debated. We report outcomes after switching from a bivalirudin-first to an unfractionated heparin (UFH)-first strategy for PCIs in a large academic center. METHODS: Patients undergoing PCI from June 1st 2013-May 31st, 2015 were identified through the National Cardiovascular Data Registry (NCDR), and divided into the "bivalirudin era" (June 2013-July 2014) and the "UFH era" (October 2014-May 2015). Bleeding outcomes were compared using multivariable logistic regression adjusted for potential confounders. RESULTS: A total of 1,145 patients were identified (bivalirudin era =752, UFH era =393). Radial access for PCI increased over time, and was lower in the bivalirudin era (26% vs. 34%, P<0.05). There were 32 major bleeds (4.3%) in the bivalirudin era and 29 major bleeds (7.4%) in the UFH era (P=0.03), with the majority being hemoglobin drops (≥3 g/dL) without overt clinical bleeding (85.7% of bleeds in the bivalirudin era and 86.2% of bleeds in the UFH era). After adjustments for other common major causes of bleeding, bivalirudin was associated with 78% lower odds of bleeding (OR =0.22; 95% CI: 0.05-0.91). CONCLUSIONS: An increase in major bleeding events occurred after switching to an UFH-first strategy, primarily associated with hemoglobin drop (≥3 g/dL) without overt clinical bleeding. Major overt bleeding was rare (0.3%) and similar in both groups. These results suggest a UFH-first strategy for PCI may have a role in patients with low bleeding risk.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Peer-reviewed clinical and outcomes research relevant to anticoagulation, leech therapy, and microsurgical flap management. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Este análisis de registro de un solo centro comparó estrategias de anticoagulación para la intervención coronaria percutánea antes y después de que la institución cambiara de un enfoque de prioridad de bivalirudina a uno de prioridad de heparina no fraccionada; entre 1.145 pacientes, el resumen informa más sangrados mayores en la era de la heparina (7,4% frente a 4,3%, P=0,03, mayormente caídas de hemoglobina sin sangrado manifiesto), con la bivalirudina asociada con un 78% menos de odds ajustadas de sangrado, mientras que el sangrado mayor manifiesto era raro y similar en ambos grupos. La relevancia para la hirudoterapia es mecanística e indirecta: la bivalirudina es un péptido sintético ingenierado a partir de hirudina, el inhibidor directo de trombina de la sanguijuela medicinal, por lo que este es un punto de datos en el mundo real en la línea evolutiva más amplia de 'secretoma de sanguijuela a fármaco anticoagulante'. Advertencia: esto es una cohorte no aleatorizada antes y después en un centro académico, sujeta a confusión por época (el acceso radial también aumentó con el tiempo) — sugiere, pero no puede establecer, una ventaja de sangrado, y se refiere a un fármaco derivado de hirudina en lugar de la terapia con sanguijuela en sí.
Citación
In-hospital outcomes after switching from a bivalirudin-first strategy to an unfractionated heparin-first strategy for percutaneous coronary interventions.
Jaswaney et al. · Cardiovascular diagnosis and therapy, 2018
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026