title: Comparative effectiveness analysis of anticoagulant strategies in a large observational database of percutaneous coronary interventions.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is the most commonly used procedure for coronary revascularization. There are multiple adjuvant anticoagulation strategies available. In this era of cost containment, we performed a comparative effectiveness analysis of clinical outcomes and cost of the major anticoagulant strategies across all types of PCI procedures in a large observational database.
  
  
  METHODS
  A retrospective, comparative effectiveness analysis of the Premier observational database was conducted to determine the impact of anticoagulant treatment on outcomes. Multiple linear regression and logistic regression models were used to assess the association of initial antithrombotic treatment with outcomes while controlling for other factors.
  
  
  RESULTS
  A total of 458,448 inpatient PCI procedures with known antithrombotic regimen from 299 hospitals between January 1, 2004 and March 31, 2008 were identified. Compared to patients treated with heparin plus glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin was associated with a 41% relative risk reduction (RRR) for inpatient mortality, a 44% RRR for clinically apparent bleeding, and a 37% RRR for any transfusion. Furthermore, treatment with bivalirudin alone resulted in a cost savings of $976 per case. Similar results were seen between bivalirudin and heparin in all end-points. Combined use of both bivalirudin and GPI substantially attenuated the cost benefits demonstrated with bivalirudin alone.
  
  
  CONCLUSIONS
  Bivalirudin use was associated with both improved clinical outcomes and decreased hospital costs in this large "real-world" database. To our knowledge, this study is the first to demonstrate the ideal comparative effectiveness end-point of both improved clinical outcomes with decreased costs in PCI.
authors.affiliation: Kettering Medical Center, Dayton, OH, USA.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Wise
authors.forename: Brian P
authors.initials: BP
authors.lastname: Schwartz
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Dittoe
authors.forename: Ammar
authors.initials: A
authors.lastname: Safar
authors.forename: Steven
authors.initials: S
authors.lastname: Sherman
authors.forename: Bruce
authors.initials: B
authors.lastname: Bowdy
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Hahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D000991:Antithrombins / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000191:economics / Q000627:therapeutic use; D006629:Hirudins / Q000191:economics; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019370:Observation; D010446:Peptide Fragments / Q000191:economics / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin