Abstract 3432: Eptifibatide plus Heparin Increases the Risk of Major and Minor Hemorrhagic Complications Compared to Bivalirudin in Patients with Normal Renal Function Undergoing Percutaneous Coronary Intervention
Background: Excess dosing of heparin and glycoprotein inhibitors occurs more frequently in patients with impaired renal function and increases the risk of hemorrhagic complications associated with percutaneous coronary intervention (PCI). Whether differences in hemorrhagic risk between anticoagulation strategies would be attenuated in patients with normal renal function, in whom excess dosing is less likely, is unknown. We assessed the risk of bleeding complications in patients with normal renal function undergoing PCI.
Methods: Of the 6010 patients in the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 Trial, we analyzed the pre-specified eptifibatide (EP) cohort (n=3317) which compared bivalirudin + provisional eptifibatide (BIV) to heparin + planned eptifibatide (H+EP) in patients undergoing elective or urgent PCI. Previous analysis of this cohort demonstrated fewer hemorrhagic complications with BIV vs. H+EP. To exclude the possibility that excess dosing contributed to an increase in hemorrhagic events, we evaluated patients from the eptifibatide cohort with normal renal function (creatinine clearance ≥ 90 mL/min).
Results: Of the 3317 patients evaluated, 1648 (50%) had normal renal function. Major and minor bleeding complications were significantly less frequent in patients treated with BIV compared with H+EP. In addition, ischemic event rates were similar for BIV vs. H+EP. Bleeding and ischemic event rates for BIV vs. H+EP are shown (Table⇓).
Conclusions: Among patients with normal renal function, in whom excess dosing is unlikely, hemorrhagic complications occur more frequently with the use of heparin plus planned eptifibatide compared to bivalirudin plus provisional eptifibatide. We conclude that the increased hemorrhagic risk associated with heparin plus eptifibatide cannot be attributed to excess dosing in this setting.