Why the study?
Does bivalirudin reduce mortality, bleeding, or stent thrombosis compared to heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI?
Does bivalirudin reduce mortality, bleeding, or stent thrombosis compared to heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary PCI?
In STEMI patients undergoing primary PCI, bivalirudin reduces major bleeding compared to heparin but increases the risk of acute stent thrombosis, with no significant difference in 30-day mortality.
May support bivalirudin to reduce bleeding in STEMI primary PCI; leaves open optimal antithrombotic balance given stent thrombosis risk.
Bivalirudin compared with heparin was associated with comparable 30-day rates of mortality with reduced major bleeding, at the price of an increased risk of acute ST, with non-significant differences in the overall 30-day rates of ST and reinfarction. Intended use of GPI in the heparin arm did not significantly modify the treatment effects of bivalirudin. Given the important differences between trials, as well as evolution in technique and adjunct pharmacotherapy, further randomized trials are warranted to discriminate whether there are substantial safety and efficacy differences between these agents during primary PCI in STEMI.
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Capodanno et al. (2015) studied this question.
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