April 12, 2011Heart
Unfractionated heparin administration in patients treated with bivalirudin during primary percutaneous coronary intervention is associated lower mortality and target lesion thrombosis: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
Why the study?
Does adding a bolus dose of unfractionated heparin to bivalirudin reduce death or target lesion thrombosis in patients undergoing primary PCI for STEMI?
Population
2,996 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention…
Comparison
Bivalirudin plus a bolus dose of unfractionated… vs Bivalirudin only
Design
Cohort
Follow-up
30 days
Authors
Discussion
Loading...
Member takes
Implication
Bivalirudin plus UFH was associated with lower 30-day risk in STEMI PCI; leaves open confirmation in randomized trials.
Key Points
- To evaluate the clinical impact of adding a bolus of unfractionated heparin to bivalirudin anticoagulation in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
- Analyzed 2,996 patients with STEMI undergoing primary PCI with bivalirudin within the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
- Compared outcomes between patients treated with bivalirudin monotherapy (n=1,928, 64%) and those receiving bivalirudin plus an adjunctive bolus of unfractionated heparin (n=1,068, 36%).
- The primary combined endpoint of 30-day death or target lesion thrombosis occurred in 6.5% of the bivalirudin plus UFH group compared with 11.3% of the bivalirudin-only group (OR 0.55, 95% CI 0.41 to 0.72, p<0.001; adjusted HR 0.64, 95% CI 0.44 to 0.95, p=0.03).
- Adjusted 30-day mortality alone did not differ significantly between bivalirudin plus UFH and bivalirudin monotherapy (5.1% vs 9.2%, adjusted HR 0.66, 95% CI 0.42 to 1.03, p=0.07).
- Definite target lesion thrombosis at 30 days was not significantly different after adjustment between the combination and monotherapy groups (1.5% vs 2.3%, adjusted HR 0.59, 95% CI 0.27 to 1.33, p=0.21).
Structured PICO
Does adding a bolus dose of unfractionated heparin to bivalirudin reduce death or target lesion thrombosis in patients undergoing primary PCI for STEMI?
P
Population
2,996 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with bivalirudin as anticoagulant, enrolled in the national Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
I
Intervention
Bivalirudin plus a bolus dose of unfractionated heparin (UFH)
C
Comparator
Bivalirudin only
O
Outcome
Combined endpoint of death or target lesion thrombosis at 30 dayscomposite
Adding a bolus dose of unfractionated heparin to bivalirudin during primary PCI for STEMI is associated with a significantly lower 30-day risk of death or target lesion thrombosis.
Cite This Study
Lagerqvist et al. (2011) studied this question.