Abstract 2650: Safety and Efficacy of Crossover from Enoxaparin or Unfractionated Heparin to Bivalirudin: Results from ACUITY
Objective: The ACUITY trial demonstrated that the use of bivalirudin monotherapy (Biv mono) resulted in superior net clinical outcomes compared to either unfractionated heparin (UFH) or enoxaparin (Enox) plus a glycoprotein IIb/IIIa inhibitor (GPI) in moderate and high risk ACS patients. Although previous ACS studies have shown that crossover from UFH to Enox and vice versa is associated with increased bleeding and ischemic events, the effect of crossover to Biv mono or remaining on consistent antithrombin (AT) therapy has not been studied.
Methods: We evaluated the incidence of net clinical outcome, composite ischemia and bleeding in patients on consistent therapy (single AT prior to angiography) and crossover therapy (single switch from UFH to Enox, Enox to UFH, or either heparin to Biv prior to angiography).
Results: Of the 13,819 patients enrolled in ACUITY, 6452 (46.7%) had consistent therapy and 4631 (33.5%) had crossover therapy. Patients receiving consistent therapy had less ischemic events and similar bleeding rates as those on crossover therapy. Within the consistent subgroup, patients receiving Biv mono had statistically significant improvements in net clinical outcome and bleeding. Outcomes were similar in the crossover subgroup except for decreased bleeding with Biv mono. See table⇓.
Conclusion: Results from patients consistently treated with Bivalirudin monotherapy support the overall ACUITY findings with significant improvements in net clinical outcome and less bleeding. Patients can be crossed over from unfractionated heparin or enoxaparin to Bivalirudin monotherapy with improved net clinical outcome and similar ischemic events but with less bleeding. Bivalirudin monotherapy is a safe and effective alternative to consistent therapy.