Bivalirudin Reduces Bleeding

Because unfractionated heparin (UFH), the main antithrombotic therapy for patients undergoing percutaneous coronary intervention (PCI), has major bleeding complications associated with higher mortality, bivalirudin has attracted considerable interest. Although the benefits of bivalirudin have been well established in terms of bleeding complications, its impact on mortality is less certain, say researchers from the University of Padua Medical School in Padua, Careggi Hospital in Florence, Papa Giovanni XXIII Hospital in Bergamo, and the Catholic University of the Sacred Heart in Rome, all in Italy; Weil Cornell Medical College in Brooklyn, Columbia University Medical Center, and the Cardiovascular Research Foundation, all in New York; and Radboud University Medical Center, Nijmegen, in The Netherlands. They add that the impact of bivalirudin on mortality, myocardial infarction (MI), and even major bleeding complications as a function of baseline hemorrhagic risk has not been studied.

The researchers say theirs is the largest meta-analysis (12 randomized trials involving 33,261 patients), to their knowledge, of trials exploring outcomes of patients undergoing bivalirudin-supported PCI. It is also the first meta-regression evaluating the efficacy and safety of bivalirudin compared with UFH as a function of the baseline hemorrhagic risk of patients treated with PCI.

Bivalirudin significantly reduced major and minor bleeding (P < .001 for both), but this analysis extends this finding by showing that bivalirudin is associated with lower bleeding regardless of baseline hemorrhagic risk. However, the benefits of the drug were not significantly different from those of UFH in terms of 30-day mortality or MI. Nonetheless, the analysis showed that the higher the baseline hemorrhagic risk, the larger the incremental benefit of bivalirudin over UFH.

Source
Tarantini G, Brener SJ, Barioli A, et al. Am Heart J. 2014;167(3):401-412.e6.
doi: 10.1016/j.ahj.2013.11.013.