Cardiologists may want to consider bivalirudin over heparin for anticoagulation when non–ST–elevation myocardial infarction (NSTEMI) patients undergo percutaneous coronary intervention (PCI), according to a new meta-analysis published in Circulation.[1] The two medications are associated with similar mortality rates, but bivalirudin is consistently linked to a lower risk of bleeding than heparin.
“The optimal procedural anticoagulation strategy for patients with NSTEMI who undergo PCI remains uncertain,” wrote contributing author Gregg Stone, MD, an interventional cardiologist and professor of cardiology with Mount Sinai in New York City, and colleagues. “The ideal regimen would reduce the risk of death, stent thrombosis and myocardial infarction (MI) while minimizing the risk of access site-related and nonaccess site-related bleeding events.”
Stone et al. examined data from five previously completed studies focused on periprocedural anticoagulation among acute MI patients undergoing PCI. The team’s research included a total of more than 12,000 patients. While 49.7% of those patients were treated with periprocedural bivalirudin, the remaining 50.3% were treated with periprocedural heparin. For both treatment groups, the mean patient age was 66 years old, and approximately 25% were women.
Overall, 30-day mortality for bivalirudin (1.2%) and heparin (1.1%) were nearly identical. Rates of cardiac mortality, reinfarction and stent thrombosis were also comparable. In fact, the one key difference between the two anticoagulation strategies was that serious bleeding events were seen in 3.3% of patients given bivalirudin and 5.3% of patients treated with heparin. This benefit was true for both access site- and nonaccess site-related bleeding events.
The authors also emphasized that treating patients with high doses of bivalirudin after PCI was not associated with a reduction in ischemic event rates. Post-PCI infusions have been found to be beneficial in STEMI patients, but the evidence suggests this is not true when treating NSTEMI patients.
“Given its safety profile, bivalirudin use may be the preferred agent for use in patients with NSTEMI undergoing PCI,” the authors concluded. “Considering its beneficial effects on both access site and nonaccess site bleeding events, bivalirudin might be particularly helpful in patients at increased bleeding risk. The latter issue should be examined in future dedicated analyses.”
This meta-analysis was completed by an international team of specialists from Mount Sinai, Brigham and Women’s Hospital, Lund University in Sweden, Bern University Hospital in Switzerland and other facilities around the world.
Click here to read the full analysis in Circulation, an American Heart Association journal.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.