Key result
Bivalirudin with provisional GP IIb/IIIa blockade was noninferior to heparin plus planned GP IIb/IIIa blockade for the composite of death, MI, urgent revascularisation, or major bleeding at 30 days.
Why the study?
Does bivalirudin with provisional GP IIb/IIIa blockade improve outcomes compared to heparin and planned GP IIb/IIIa blockade in patients undergoing percutaneous coronary intervention?
RCT
Does bivalirudin with provisional GP IIb/IIIa blockade improve outcomes compared to heparin and planned GP IIb/IIIa blockade in patients undergoing percutaneous coronary intervention?
Bivalirudin with provisional GP IIb/IIIa blockade is a non-inferior alternative to heparin plus planned GP IIb/IIIa blockade for patients undergoing PCI, offering a lower risk of bleeding.
Answers are grounded in this paper and cite their sources.
May support bivalirudin provisional strategy to limit bleeding in PCI; leaves open confirmation in contemporary RCTs with modern stents and P2Y12 inhibitors.
The combined use of low dose heparin and glycoprotein (GP) IIb/IIIa blockers is standard treatment during percutaneous coronary interventions (PCIs). Bivalirudin has a different mechanism of anticoagulant action than heparin. In REPLACE-2, patients undergoing PCI were randomised to bivalirudin with provisional GP IIb/IIIa blockade or heparin and planned GP IIb/IIIa blockade. The primary quadruple composite end point was death, myocardial infarction, urgent repeat revascularisation or in-hospital major bleeding by 30 days, and statistical analysis showed that bivalirudin was not inferior to heparin plus GP IIb/IIIa blockade. There were fewer major and minor bleeding events with bivalirudin than with heparin plus GP IIb/IIIa blockade. Bivalirudin and provisional GP IIb/IIIa blockade should now be considered as an alternative to heparin plus planned GP IIb/IIIa blockade in patients undergoing urgent or elective revascularisation.
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Sheila A Doggrell (2003) conducted an RCT in Percutaneous coronary intervention (PCI). Bivalirudin with provisional GP IIb/IIIa blockade vs. Heparin and planned GP IIb/IIIa blockade was evaluated on Death, myocardial infarction, urgent repeat revascularisation or in-hospital major bleeding by 30 days. Bivalirudin with provisional GP IIb/IIIa blockade was noninferior to heparin plus planned GP IIb/IIIa blockade for the composite of death, MI, urgent revascularisation, or major bleeding at 30 days.
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