May 9, 2014European Heart Journal
Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction
Why the study?
Does prasugrel plus bivalirudin improve net clinical outcomes compared to clopidogrel plus heparin in patients with STEMI undergoing primary PCI?
Population
548 patients with ST-segment elevation myocardial infarction with planned primary percutaneous coronary…
Comparison
Prasugrel plus bivalirudin vs Clopidogrel plus unfractionated heparin
Design
RCT, randomized, open-label
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Prasugrel plus bivalirudin shows no net clinical benefit over clopidogrel plus heparin in STEMI primary PCI; leaves optimal antithrombotic strategy unresolved due to underpowering.
Structured PICO
Does prasugrel plus bivalirudin improve net clinical outcomes compared to clopidogrel plus heparin in patients with STEMI undergoing primary PCI?
P
Population
548 patients with ST-segment elevation myocardial infarction (STEMI) with planned primary percutaneous coronary intervention (PCI)
I
Intervention
Prasugrel plus bivalirudin
C
Comparator
Clopidogrel plus unfractionated heparin
O
Outcome
Composite endpoint of death, myocardial infarction, unplanned revascularization of the infarct related artery, stent thrombosis, stroke, or bleeding at 30 dayscomposite
A strategy of prasugrel plus bivalirudin did not significantly differ from clopidogrel plus unfractionated heparin in reducing 30-day net clinical outcomes in STEMI patients undergoing primary PCI, though the trial was underpowered due to early termination.
Limitations
- Premature termination of the trial owing to slow recruitment
Cite This Study
Schulz et al. (2014) studied this question.