Bivalirudin Compared With Heparin During Coronary Angioplasty for Thrombus-Containing Lesions

Objectives. We investigated whether bivalirudin is more effective than heparin in preventing ischemic complications in high risk patients undergoing coronary angioplasty for thrombus-containing lesions detected by angiography. Background. Heparin is administered during coronary angioplasty to preven...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1997-11, Vol.30 (5), p.1264-1269
Main Authors: Shah, Pinak B, Ahmed, Waqar H, Ganz, Peter, Bittl, John A
Format: Article
Language:English
Subjects:
Aged
Angioplasty, Balloon, Coronary
Anticoagulants - therapeutic use
Antithrombins - therapeutic use
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Coronary Thrombosis - therapy
Double-Blind Method
Female
Heparin - therapeutic use
Hirudin Therapy
Hirudins - analogs & derivatives
Humans
Male
Medical sciences
Middle Aged
Multicenter Studies as Topic
Myocardial Ischemia - etiology
Myocardial Ischemia - prevention & control
Peptide Fragments - therapeutic use
Pharmacology. Drug treatments
Randomized Controlled Trials as Topic
Recombinant Proteins - therapeutic use
Treatment Outcome
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Summary:Objectives. We investigated whether bivalirudin is more effective than heparin in preventing ischemic complications in high risk patients undergoing coronary angioplasty for thrombus-containing lesions detected by angiography. Background. Heparin is administered during coronary angioplasty to prevent closure of the dilated vessel. Bivalirudin (Hirulog) is a direct thrombin inhibitor that can be safely substituted for heparin during angioplasty. Bivalirudin has several theoretic advantages over heparin as an anticoagulant agent. Methods. We performed an observational analysis of the Hirulog Angioplasty Study in which 4,098 patients with unstable or postinfarction angina were randomized to receive either bivalirudin or heparin during coronary angioplasty. The study group for this analysis consisted of 567 patients who had thrombus-containing lesions on angiography. The primary end point was death, myocardial infarction, emergency coronary artery bypass graft surgery or abrupt vessel closure before hospital discharge. Results. Patients with thrombus-containing lesions had a higher incidence of myocardial infarction (5.1% vs. 3.2%, p = 0.03) and abrupt vessel closure (13.6% vs. 8.3%, p < 0.001) than those without thrombus. In patients with thrombus-containing lesions, however, the incidence of the primary end point was not different between the bivalirudin and heparin treatment groups. Furthermore, no difference in the incidence of ischemic events at 6 months was seen between the treatment groups. Conclusions. Bivalirudin is not more effective than heparin in preventing ischemic complications in patients undergoing coronary angioplasty for thrombus-containing lesions detected by angiography. Other approaches, perhaps involving potent antiplatelet agents, should be considered for patients with thrombus-containing lesions.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(97)00274-X