title: Benefit of bivalirudin versus heparin after transradial and transfemoral percutaneous coronary intervention.
abstract: Bivalirudin, a direct thrombin inhibitor, has been shown to reduce major bleeding and provide a better safety profile compared to unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI) through transfemoral access. Data pertaining to the clinical benefit of bivalirudin compared to UFH monotherapy in patients undergoing transradial PCI are lacking. The present study sought to compare the in-hospital net clinical adverse events, including death, myocardial infarction, target vessel revascularization, and bleeding, for these 2 antithrombotic regimens for all patients at a tertiary care, high-volume radial center. From April 2009 to February 2011, all patients treated with bivalirudin were matched by access site to those receiving UFH. The patients in the bivalirudin group (n = 125) were older (72 ± 13 years vs 66 ± 11 years; p <0.0001), more often had chronic kidney disease (51% vs 30%; p = 0.0012), and more often underwent primary PCI (30% vs 14%, p <0.0037) than the UFH-treated patients (n = 125). A radial approach was used in 71% of both groups. The baseline bleeding risk according to Mehran's score was similar in both groups (14 ± 9 vs 15 ± 8, p = 0.48). In-hospital mortality was 2% in both groups (p = 1.00). No difference in net clinical adverse events or ischemic or bleeding complications was detected between the 2 groups. Bivalirudin reduced both ischemic and bleeding events in femoral-treated patients, but no such clinical benefit was observed in the radial-treated patients. In conclusion, as periprocedural PCI bleeding avoidance strategies have become paramount to optimize the clinical benefit, the interaction between bivalirudin and radial approach deserves additional investigation.
authors.affiliation: Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: MacHaalany
authors.forename: Eltigani
authors.initials: E
authors.lastname: Abdelaal
authors.forename: Yoann
authors.initials: Y
authors.lastname: Bataille
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.forename: Pierre
authors.initials: P
authors.lastname: Duranleau-Gagnon
authors.forename: Éric
authors.initials: É
authors.lastname: Larose
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D063128:Tertiary Health Care; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin