Abstract 2831: Bleeding Risk and Outcomes of Bivalirudin versus Glycoprotein IIb/IIIa Inhibitors with Targeted Low-dose Unfractionated Heparin in Elective Percutaneous Coronary Intervention
Background: In patients undergoing elective percutaneous coronary intervention (PCI), procedural anti-coagulation with bivalirudin has been previously shown to significantly reduce bleeding complications at the cost of a modest increase in ischemic events when compared to unfractionated heparin (UFH) and glycoprotein IIb/IIIa inhibitors (GPI). However, the excess bleeding in UFH and GPI patients may have been due to excessively high UFH doses. This study sought to determine the bleeding risk of targeted low dose UFH with GPI compared to bivalirudin in patients undergoing elective PCI.
Methods: Of 1231 patients undergoing elective PCI included in the analysis, 616 patients underwent PCI with adjunctive UFH and GPI with the UFH dose targeted to an ACT of 250 seconds, and 615 patients matched for baseline characteristics underwent PCI with bilvalirudin. Outcomes were analyzed for major bleeding (hematocrit drop > 15g/dL, GI bleed or major hematoma) and 12-month MACE (death, myocardial infarction and target lesion revascularization).
Results: The maximum ACT achieved was 260.9±61.5 in the UFH/GPI group and 349.3±58.6 in the bivalirudin group (p<0.001). In hospital major bleeding was similar between the two groups (1.9% UFH/GPI vs. 1.5% bivalirudin, p=0.51) as were transfusion requirements (1.4% UFH/GPI vs. 1.1% bivalirudin, p=0.61). 12-month MACE was also similar between the two groups (10.0% UFH/GPI vs. 9.9% bivalirudin, p=0.95).
Conclusion: There are no significant differences in major bleeding and 12-month MACE for patients undergoing elective PCI treated with bivalirudin or UFH and GPI when the UFH dose is targeted to an ACT of 250 seconds.