Safety of bivalirudin in percutaneous coronary intervention following thrombolytic therapy.
ABSTRACT OBJECTIVES: To evaluate the safety of bivalirudin (BIV) use during percutaneous coronary intervention (PCI) following thrombolytic therapy in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: BIV has emerged as a safer anticoagulant than unfractionated heparin (UFH) during primary PCI; however, its use in patients who receive thrombolytic therapy has not been established. METHODS: A consecutive series of 104 patients who presented with STEMI, treated with full-dose thrombolytics, and who subsequently received PCI within 6 hours was identified and analyzed. BIV use was compared to UFH for in-hospital bleeding and ischemic events. The primary end points were the rate of major bleeding and the rate of net adverse clinical events as defined in the HORIZONS-AMI trial. The study cohort consisted of 104 patients, of whom 47 (45%) received BIV and 57 (55%) received UFH. RESULTS: Patients on BIV were more frequently pre-loaded with clopidogrel, while intra-procedural glycoprotein IIb/IIIa inhibitors were used only in UFH patients. In-hospital death, ischemic events, and Thrombolysis In Myocardial Infarction major bleeding occurred more frequently in patients treated with UFH. The net adverse clinical events rate was lower in the intra-procedural BIV group (3 [6.4%] vs. 12 [21.1%] UFH, p=0.034). CONCLUSION: The use of BIV in patients presenting with STEMI who were pretreated with thrombolytic therapy and who subsequently underwent PCI is safe and is associated with less ischemic and bleeding events when compared to UFH, and should be considered as the first line anticoagulant for these patients during PCI. © 2012 Wiley Periodicals, Inc.