Impact of bivalirudin on in-hospital bleeding and six-month outcomes in octogenarians undergoing percutaneous coronary intervention.
OBJECTIVE
This study aimed to analyze the impact of replacing heparin with bivalirudin in octogenarians undergoing percutaneous coronary intervention (PCI) on postprocedure hemorrhage and 6-month mortality.


BACKGROUND
Randomized trials comparing the antithrombin agent bivalirudin with heparin as the intraprocedural anticoagulant identify a reduction in periprocedural bleeding after PCI. Further, the occurrence of such bleeding seems to predict an increased risk of death or myocardial infarction both in-hospital and at long-term follow-up. Importantly, elderly people who are at the greatest risk of post-PCI bleeding complications are underrepresented in these randomized trials.


METHODS
From 2000 to 2007, 2,766 consecutive patients from our center who were > or = 80 years of age underwent PCI with stent implantation and were included in this analysis. Bivalirudin was used in 1,207 (43.6%) patients and heparin in 1,559 (56.4%). We compared the rates of post-PCI bleeding complications and 6-month mortality.


RESULTS
The overall in-hospital bleeding and 6-month mortality rates were 4.6% and 11.8%, respectively. By multivariate logistic regression and after adjustment by propensity score analysis, bivalirudin was associated with a significant decrease in in-hospital bleedings (HR = 0.41, 95% CI = 0.23-0.73, P = 0.003). By multivariate Cox analysis, bivalirudin was also associated with a significant decrease (HR = 0.6, 95% CI = 0.4-0.9, P = 0.01) and in-hospital bleedings with a significant increase in the 6-month mortality (HR = 2.5, 95% CI = 1.6-3.9, P < 0.001).


CONCLUSIONS
This study suggests an important subset for use of bivalirudin in lieu of heparin that will benefit the very elderly.
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Gilles
G
Lemesle
Axel
A
De Labriolle
Laurent
L
Bonello
Asmir
A
Syed
Sara
S
Collins
Gabriel
G
Maluenda
Rebecca
R
Torguson
Kimberly
K
Kaneshige
Zhenyi
Z
Xue
William O
WO
Suddath
Lowell F
LF
Satler
Kenneth M
KM
Kent
Joseph
J
Lindsay
Augusto D
AD
Pichard
Ron
R
Waksman
D000367:Age Factors; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D000925:Anticoagulants / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D010446:Peptide Fragments / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin