ANTICOAGULANT SUPPORT OF PERCUTANEOUS CORONARY INTERVENTIONS WITH BIVALIRUDIN OR UNFRACTIONATED HEPARIN AT VARIOUS VASCULAR ACCESSES

Abstract

Purpose. Nowadays it is proved that the use of bivalirudin instead of unfractionated heparin (UFH) during primary percutaneous coronary intervention (PCI) allows to reduce the number of bleeding complications. But at the same time there is no conclusive data on the clinical advantage of the use of bivalirudin over UFH during planned PCI. The purpose of the work was a comparison of shortterm and longterm results of PCI in subjects with stable coronary artery disease (CAD) associated with the infusion of bivalirudin and heparin, depending on the type of vascular access (transradial and transfemoral). Materials and methods. The study included 127 stable CAD subjects who underwent a planned PCI. By the method of simple randomization the subjects were divided into two groups: «Bivalirudin + transfemoral access» group (n=65) – bivalirudin was used as an anticoagulant during the intervention by femoral access and «Heparin + transradial access» group (n=62). The groups were comparable on major clinical and demographic indicators and risk factors for bleeding complications (14±7 vs. 13±6 scores on «Mehran Score», p=0,451). Endpoints were death, myocardial infarction (MI), repeated myocardial revascularization (RMR), episodes of bleeding during hospitalization and the total number of adverse cardiovascular events during hospitalization and in 1 year after randomization. Results. After 30 days of observation, the group «bivalirudin» (transfemoral access, n=65) and the group «UFH» (transradial access, n=62) did not differ in the number of fatal outcomes (no cases in both groups), the frequency of RMR (1,5% vs 1,6%, correspondingly, p=0,998), MI (3,1% vs. 1,6%, correspondingly, p=0,899), bleeding episodes during the hospital stay (4,6%, vs. 3,2%, correspondingly, p=0,899). The total number of cardiovascular complications was 4,6% and 3,2%, correspondingly, p=0,675. The results of one year follow-up in both groups also did not differ in the number of fatal outcomes (0% vs. 1,6%, correspondingly, p=0,946), MI (7,7% vs. 6,5%, correspondingly, p=0,656), RMR (7,7% vs. 4,8%, correspondingly, p=0,785), MACE (15,3% vs. 11,3%, correspondingly, p=0,677). Conclusion. Short-term and long-term results of planned PCI performed by transradial access with UFH anticoagulant support and PCI performed by transfemoral access ) associated with administration of bivalirudin are comparable both in the number of postoperative bleeding complications and in the number of adverse cardiovascular events.