Abstract 16983: Patterns of Use and Outcomes of Antithrombotic Therapy in End Stage Renal Disease Patients Undergoing PCI: Observations From NCDR
Introduction: Patients with ESRD have been largely excluded from contemporary trials evaluating antithrombotic therapies in PCI. In this context, registry data provides an opportunity to examine patterns of use and outcomes with unfractionated heparin (UFH) and bivalirudin in ESRD patients undergoing PCI.
Methods: Using the NCDR CathPCI Registry, patients with ESRD undergoing PCI who received monotherapy with either UFH or bivalirudin from 2009-2015 (N=71,675) were identified. Use of each agent over time was examined. In-hospital bleeding and mortality were compared and adjusted using the validated CathPCI Registry logistic regression models with generalized estimating equations using UFH as the reference.
Results: Bivalirudin was used in 51.3% of patients vs. 48.7% for UFH. The use of bivalirudin decreased over time and in 2014, UFH became the more frequently used agent (Figure 1). Patients receiving UFH were more likely to have had a prior MI (43% vs. 38%), CHF (42% vs. 37%) and STEMI (5.16% vs 3.87%) or NSTEMI (32.6% vs. 23.5%) at presentation. The access site was more often radial in patients receiving UFH (9.38% vs. 3.06%) and cardiogenic shock pre-PCI was more frequent in the UFH group (3.74% vs. 1.98 %). The observed event rates for major bleeding (7% vs. 9.5%; adjusted OR: 0.80; 95% CI: 0.74 to 0.85) and in-hospital mortality (2.6% vs. 4.2%; adjusted OR: 0.86; 95% CI: 0.77 to 0.95) were lower for patients receiving bivalirudin vs. those receiving UFH.
Conclusions: In ESRD patients undergoing PCI, bivalirudin and UFH were used with similar frequency, although patterns of use changed over the enrollment period. UFH was used in more patients with cardiogenic shock and MI. ESRD patients undergoing PCI had lower adjusted risks observed with bivalirudin, however, given the observational nature of this analysis, a randomized trial of antithrombotic strategies in ESRD patients undergoing PCI is warranted.
Author Disclosures: J.B. Washam: None. L.A. McCoy: None. D.M. Wojdyla: None. M.R. Patel: None. A.J. Klein: None. J.D. Abbott: None. S.V. Rao: None.
- © 2016 by American Heart Association, Inc.