Bivalirudin versus heparin use for patients undergoing PPCI

Abstract

Adeel Shahzad and colleagues1Shahzad A Kemp I Mars C et al.for the HEAT-PPCI trial investigatorsUnfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial.Lancet. 2014; 384: 1849-1858Summary Full Text Full Text PDF PubMed Scopus (445) Google Scholar showed that the use of heparin, compared with bivalirudin, substantially reduces the incidence of major adverse events (principally acute stent thrombosis) in patients, with no differences between the two drugs in bleeding complications. The rates of acute stent thrombosis were 3·4% in the bivalirudin group and 0·9% in the heparin group. These results should urge health-care providers to refrain from using bivalirudin in the setting of primary percutaneous coronary intervention, especially for patients with risk factors of acute stent thrombosis. In this study1Shahzad A Kemp I Mars C et al.for the HEAT-PPCI trial investigatorsUnfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial.Lancet. 2014; 384: 1849-1858Summary Full Text Full Text PDF PubMed Scopus (445) Google Scholar the absolute rates of acute stent thrombosis were higher than reported in the HORIZONS-AMI trial.2Stone GW Witzenbichler B Guagliumi G et al.for the HORIZONS-AMI Trial InvestigatorsBivalirudin during primary PCI in acute myocardial infarction.N Engl J Med. 2008; 358: 2218-2230Crossref PubMed Scopus (1599) Google Scholar Patients' backgrounds might have differed between the two studies; however, the risk factors of patients who developed stent thrombosis were not shown. Risk factors for acute stent thrombosis included stent length, congestive heart failure, and a prothrombogenic state (eg, having metastatic cancer).3Luscher TF Steffel J Eberli FR et al.Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications.Circulation. 2007; 115: 1051-1058Crossref PubMed Scopus (816) Google Scholar We would like the authors1Shahzad A Kemp I Mars C et al.for the HEAT-PPCI trial investigatorsUnfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial.Lancet. 2014; 384: 1849-1858Summary Full Text Full Text PDF PubMed Scopus (445) Google Scholar to comment about patient and procedural characteristics for those with acute stent thrombosis. We declare no competing interests. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trialCompared with bivalirudin, heparin reduces the incidence of major adverse ischaemic events in the setting of PPCI, with no increase in bleeding complications. Systematic use of heparin rather than bivalirudin would reduce drug costs substantially. Full-Text PDF Open AccessBivalirudin versus heparin use for patients undergoing PPCI – Authors' replyAlthough the results of trials comparing heparin and bivalirudin are often portrayed as discordant and perplexing, we believe that there are some consistent messages from these and that common ground could be established to determine best practice. Full-Text PDF