Key result
Domestic bivalirudin was not inferior to heparin for procedural success (100.0% vs 98.2%, P>0.05) during elective PCI, but had superior safety with lower 30-day mild bleeding (1.9% vs 8.8%).
Why the study?
Does domestic bivalirudin improve efficacy and safety compared to non-fractional heparin in elective PCI candidates?
RCT (n=218)
Single-blind
randomized
Yes
Does domestic bivalirudin improve efficacy and safety compared to non-fractional heparin in elective PCI candidates?
Domestic bivalirudin provides non-inferior efficacy and superior safety (reduced mild bleeding) compared to unfractionated heparin during elective PCI.
Domestic bivalirudin offers a safer alternative to heparin in elective PCI; confirms non-inferior efficacy with reduced mild bleeding in this RCT.
BACKGROUND: Bivalirudin was widely used as an anticoagulant during coronary interventional procedure in western countries. However, it was not available in China before this clinical trial was designed. This randomized, single-blind and multicenter clinical trial aimed to evaluate the efficacy and the safety of domestic bivalirudin during percutaneous coronary intervention (PCI). METHODS: A randomized, single-blind, multicenter trial was designed. Elective PCI candidates in five centers were randomized into a bivalirudin group and a heparin group, which were treated with domestic bivalirudin and non-fractional heparin during the PCI procedure. The efficacy was evaluated by comparing the activated coagulation time (ACT), the procedural success rate (residual stenosis < 20% in target lesions without any coronary artery related adverse events within 24 hours after PCI), and the survival rate without major adverse cardiac events at 30 days after PCI between the two groups. Safety was evaluated by the major/minor bleeding rate. RESULTS: A total of 218 elective PCI patients were randomized into a bivalirudin group (n = 110) and heparin group (n = 108). Except for two patients needing additional dosing in the heparin group, the ACT values of all other patients in both groups were longer than 225 seconds at 5 minutes after the first intravenous bolus. Procedural success rates were respectively 100.0% and 98.2% in the bivalirudin group and heparin group (P > 0.05). Survival rates without major adverse cardiac events at 30 days after PCI were 100.0% in the bivalirudin group and 98.2% in the heparin group (P > 0.05). Mild bleeding rates were 0.9% and 6.9% (P < 0.05) at 24 hours, and 1.9% and 8.8% (P < 0.05) at 30 days after PCI in the bivalirudin group and heparin group respectively. There was one severe gastrointestinal bleeding case in the heparin group. CONCLUSIONS: Domestic bivalirudin is an effective and safe anticoagulant during elective PCI procedures. The efficacy is not inferior to heparin, but the safety is superior to heparin.
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Xiang et al. (2013) conducted an RCT in Elective percutaneous coronary intervention (PCI) (n=218). Domestic bivalirudin vs. Non-fractional heparin was evaluated on Procedural success rate (residual stenosis < 20% in target lesions without any coronary artery related adverse events within 24 hours after PCI) (p=> 0.05). Domestic bivalirudin was not inferior to heparin for procedural success (100.0% vs 98.2%, P>0.05) during elective PCI, but had superior safety with lower 30-day mild bleeding (1.9% vs 8.8%).
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