Abstract 15708: Does Targeted Low Dose Heparin Negate the Efficacy and Safety of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention? Insights from a Propensity Score Matched Analysis of the EVENT Registry
Background: Randomized trials have shown reduced bleeding with bivalirudin when compared to heparin in patients undergoing percutaneous coronary intervention (PCI). However, it is not known if this relative benefit is sustained in comparison with targeted low dose heparin (as measured by ACT).
Methods: Patients enrolled in the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry, a multicenter registry of unselected patients undergoing PCI, were divided into 3 groups based on the antithrombotic used during PCI [heparin, heparin+GPIIBIIIA or bivalirudin]. Propensity score matching, (1:1 matching without replacement) was used to adjust for baseline characteristics (89 variables) and compare bivalirudin vs. heparin treatment and bivalirudin vs. heparin+GPIIBIIIA treatment groups. The heparin-treated groups were sub-divided based on ACT achieved (optimal ACT defined as 250–300 for heparin alone and 200–250 when GPIIBIIIA was also used). The primary bleeding outcome was a composite of access site bleeding, hemorrhage, transfusion, or other bleeding complications at discharge. Ischemic outcomes (death/myocardial infarction/ revascularization) were evaluated at discharge and at 12 month follow-up.
Results: Propensity score matching yielded 3022 patients for the heparin vs. bivalirudin comparison and 3520 patients for the heparin+GPIIBIIIA vs. bivalirudin comparison. Bivalirudin use was associated with lower bleeding rates at all categories of achieved ACT when compared with heparin (Figure A) or heparin+GPIIBIIIA (Figure B) groups, and was not associated with an increase in ischemic outcomes either at discharge or at 12 months (data to be presented).
Conclusions: In a real world cohort of patients undergoing PCI, bivalirudin during PCI is associated with a lower risk of bleeding at all comparator ACT groups without increase in ischemic outcomes.
- © 2010 by American Heart Association, Inc.