Abstract 2848: Is There a Benefit to Bivalirudin and Glycoprotein 2b/3a Receptor Inhibitor Combination Therapy in Percutaneous Coronary Intervention?
Background: Bivalirudin and Glycoprotein 2b/3a receptor inhibitor (GPI) combination therapy offers theoretic advantages over standard unfractionated heparin and GPI combination therapy, including less platelet activation and bleeding. However, the utilization, safety and efficacy of such therapy remain unknown in the real-world setting.
Methods: Of 4586 patients who underwent PCI at our institution between January 2003 and June 2005, we identified those who received bivalirudin and GPI combination therapy (7.0% of all patients, 16.3% of bivalirudin patients, n=323). Patient demographic and clinical characteristics, as well as in-hospital outcomes, were compared to those who received unfractionated heparin and GPI combination therapy (46.3% of all patients, n=2124).
Results: The majority presented with unstable angina, although less likely in the bivalirudin/GPI group (58.9% vs. 65.7%, p<0.02). Bavalirudin/GPI patients were also less likely White (75.2% vs. 83.2%, p<0.001) and less likely to present with acute myocardial infarction (MI, 6.2% vs. 14.6%, p<0.001), hemodynamic instability (0.0% vs. 1.3%, p<0.05), or prior MI within six months (1.9% vs. 5.8%, p<0.01). Other important characteristics did not differ between groups, including age, gender, diabetes, hypertension, vascular disease, chronic bronchitis, ejection fraction and presentation with heart failure, shock or renal disease. Bivalirudin/GPI patients were similarly likely (p=NS for all) to experience in hospital death (0.6% vs. 0.9%), transmural MI (0.3% vs. 0.2%), non-transmural MI (1.9% vs. 1.0%), stroke (0.0% vs. 0.2%), subacute thrombosis (0.6% vs. 0.8%), access site injury (0.9% vs. 0.3%) and blood transfusion (6.2 % vs. 4.9%) when compared to those who received heparin/GPI. The combined endpoint of in-hospital death, MI or stroke likewise did not differ between groups (2.8% vs. 2.2%, p=NS).
Conclusions: Despite more favorable baseline characteristics, patients receiving bivalirudin/GPI combination therapy had similar incidences of in-hospital ischemic events and complications when compared to patients receiving heparin/GPI therapy. Theoretic advantages to bivalirudin/GPI combination therapy are not apparent in real-world experience.