Bivalirudin found to be safer and more effective than heparin for treating heart attack patients undergoing percutaneous coronary intervention

The most common anticoagulant used during primary percutaneous coronary intervention is heparin. However, its effects can be somewhat unpredictable, leading to higher-than-desirable rates of bleeding and blood clots. Bivalirudin is a newer anticoagulant that has more predictable "blood thinning" effects.

Bivalirudin is a safer and more effective anticoagulant than heparin for treating patients with the most serious type of heart attacks who undergo urgent percutaneous coronary intervention (PCI), and can lower the risk of death or major bleeding by 31 percent finds a study, study was a Late Breaking Clinical Trial presentation at the American Heart Association's Scientific Sessions (AHA 22) in Chicago, and published in The Lancet.

The study identifies the best and safest treatment course for patients undergoing stenting to treat a STEMI heart attack,compared with heparin, bivalirudin plus a short infusion substantially improved the likelihood of surviving a STEMI and reduced the two most feared complications-major bleeding and stent thrombosis.

In the "BRIGHT-4" trial, patients with STEMI heart attacks underwent "primary PCI"-an emergency stenting procedure to preserve heart muscle function. Patients require anticoagulant therapy during this minimally invasive procedure to successfully open the blocked heart artery and prevent future blood clots from forming and causing another heart attack.

This new research evaluates the two most widely used regimens of heparin and bivalirudin, which have never been directly compared with each other in an adequately sized trial. Investigators followed patients for 30 days following the procedure, the timeframe in which STEMI patients are at highest risk for adverse events. Researchers found that 4.4 percent of patients treated with heparin died or had a major bleed within 30 days, compared to 3.1 percent of patients treated with bivalirudin. Overall, the bivalirudin group had a 31 percent reduction in the rate of death or major bleeding compared with patients in the heparin group.

They found that deaths were reduced from 3.9 percent in heparin-treated patients to 3.0 percent in bivalirudin-treated patients. Severe bleeding also was reduced from 0.8 percent in the heparin group to 0.2 percent in the bivalirudin group.

Researchers concluded that the simple decision to use bivalirudin during primary percutaneous coronary intervention in patients with heart attacks, which is now generic and thus inexpensive, can save hundreds of thousands of lives per year and prevent major bleeding and stent thrombosis compared with heparin.

Reference:

Bivalirudin found to be safer and more effective than heparin for treating heart attack patients undergoing percutaneous coronary intervention; THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE; JOURNAL-The Lancet.