Abstract 15074: Safety and Efficacy of Peri-Procedural Heparin Plus Short Term Infusion of Tirofiban Versus Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: Results From The Intermountain Heart Collaborative Study
Introduction: A primary conflict in anticoagulation during percutaneous coronary intervention (PCI) is the simultaneous desire to prevent both thrombosis and bleeding. In modern PCI with standard dual oral antiplatelet therapy, the use of heparin + short (<6 hrs) infusions of glycoprotein IIb/IIIa inhibitors, or short infusions of bivalirudin alone, have been proposed as potentially superior alternatives to heparin plus more prolonged infusions. However, which strategy of short term anticoagulation during PCI is best is unknown. Therefore, we compared the safety and efficacy of heparin plus short term infusions of tirofiban (S-tirofiban) versus bivalirudin during elective or urgent PCI.
Methods: From January 2013 to December 2015, patients who underwent successful PCI without cardiogenic shock and were anticoagulated using S-tirofiban or bivalirudin were studied. TIMI major bleed (including any transfusion) at 30 days and death, nonfatal MI and urgent target vessel revascularization (UTVR) at 1 year were ascertained.
Results: A total of 402 PCI patients receiving S-tirofiban (age=64±13 yrs, males=75%, diabetes = 39%, smokers=26%, acute coronary syndrome presentation (ACS) = 77%) and 455 patients receiving bivalirudin, (age=65±13 yrs, males=71%, diabetes = 42%, smokers=26%, ACS=79%) were included. TIMI major bleed was 1.2% and 3.1% for S-tirofiban and bivalirudin respectively. Adverse events at 1 year were death (3.4% and 5.5%), MI (2.9% and 3.0%), UTVR (2.0% and 1.5%) for S-tirofiban and bivalirudin respectively. See table for multivariable results.
Conclusion: During PCI, when comparing the efficacy of S- tirofiban versus bivalirudin, no significant differences for 30 day TIMI major bleeding or 1 year death, MI or UTVR were identified. Although trends towards reductions in both TIMI major bleeding and death were observed with the use of S-tirofiban, due to the generally low incidence of any adverse events, no statistical significance was reached.
Author Disclosures: J.B. Muhlestein: None. H.T. May: None. T.L. Bair: None. V.T. Le: None. J.L. Anderson: None. B.K. Whisenant: None. K.U. Knowlton: None. D.L. Lappe: None.
- © 2016 by American Heart Association, Inc.