title: The effect of bivalirudin on costs and outcomes of treatment of ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Bivalirudin is commonly used during percutaneous coronary intervention (PCI) rather than unfractionated heparin. The higher cost of bivalirudin may be offset if it reduces costly bleeding complications and/or length of stay. We sought to assess the effect of using bivalirudin on the costs of care among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI.
  
  
  METHODS
  We analyzed data from 64,872 patients treated in 1 of 278 hospitals. The effect of overall hospital use of bivalirudin on clinical and economic outcomes was assessed using multivariable regression, based on average hospital use of treatments.
  
  
  RESULTS
  The use of bivalirudin among patients with STEMI treated with PCI varied widely across hospitals, with a median of 6.9% (interquartile range 2.3%-18.6%). After controlling for patient and hospital characteristics, use of bivalirudin rather than heparin and a glycoprotein IIb/IIIa inhibitor reduced bleeding (odds ratio 0.47, P < .001), length of stay (-0.47 days, P < .03), and hospital costs (-14%, P < .04).
  
  
  CONCLUSIONS
  Use of bivalirudin among patients with STEMI treated with PCI appears to reduce bleeding and overall costs.
authors: School of Business and Law School, Stanford University, Stanford, CA 94305, USA. fkessler@stanford.edu
authors: Daniel P
authors: DP
authors: Kessler
authors: Eugene
authors: E
authors: Kroch
authors: Mark A
authors: MA
authors: Hlatky
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D000991:Antithrombins / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006629:Hirudins; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D010446:Peptide Fragments / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin