Ticagrelor vs. clopidogrel in bivalirudin-treated patients with STEMI undergoing primary PCI: The BRIGHT-4 trial

BACKGROUND AND AIMS: The optimal antiplatelet agent regimen in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) with bivalirudin anticoagulation is uncertain. This analysis sought to evaluate the safety and efficacy of ticagrelor compared with clopidogrel in patients with STEMI treated with PPCI with radial artery access and bivalirudin anticoagulation. METHODS: This post-hoc analysis compared bivalirudin plus ticagrelor with bivalirudin plus clopidogrel in 3009 BRIGHT-4 patients that were treated with PPCI. The primary endpoint was all-cause death or Bleeding Academic Research Consortium (BARC) types 3-5 bleeding occurring within 30 days. RESULTS: The 30-day all-cause death or BARC types 3-5 bleeding occurred in 2.0 % of patients treated with ticagrelor vs. 3.9 % of patients treated with clopidogrel (HR 0.51, 95 % CI 0.29 to 0.89; P = 0.02), driven by a reduction in all-cause death with ticagrelor (1.9 % vs. 3.7 %; P = 0.02) with no difference in BARC types 3-5 bleeding (0.1 % vs. 0.3 %; P = 0.34), although BARC type 2 bleeding was increased with ticagrelor (2.7 % vs. 1.2 %; P = 0.02). There was no significant difference between two groups in risk of stent thrombosis and composite of all-cause death, recurrent myocardial infarction, ischemia-driven target vessel revascularization, or stroke. CONCLUSIONS: Among patients with STEMI treated with PPCI, the risk of the composite of all-cause mortality and BARC types 3-5 bleeding at 30 days was lower with ticagrelor than with clopidogrel on a background of bivalirudin, without an increase in stent thrombosis and major bleedings.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Post-hoc analysis of 3009 STEMI patients in the BRIGHT-4 RCT comparing ticagrelor vs. clopidogrel on a bivalirudin background during primary PCI. Ticagrelor reduced 30-day all-cause death/major bleeding composite without increasing stent thrombosis.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Ensayos clínicos.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review — Foppiani J et al. (2024)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)

Browse all ASH-analysed research →