title: Evaluation on the efficacy and safety of domestic bivalirudin during percutaneous coronary intervention.
abstract: BACKGROUND
  Bivalirudin was widely used as an anticoagulant during coronary interventional procedure in western countries. However, it was not available in China before this clinical trial was designed. This randomized, single-blind and multicenter clinical trial aimed to evaluate the efficacy and the safety of domestic bivalirudin during percutaneous coronary intervention (PCI).
  
  
  METHODS
  A randomized, single-blind, multicenter trial was designed. Elective PCI candidates in five centers were randomized into a bivalirudin group and a heparin group, which were treated with domestic bivalirudin and non-fractional heparin during the PCI procedure. The efficacy was evaluated by comparing the activated coagulation time (ACT), the procedural success rate (residual stenosis < 20% in target lesions without any coronary artery related adverse events within 24 hours after PCI), and the survival rate without major adverse cardiac events at 30 days after PCI between the two groups. Safety was evaluated by the major/minor bleeding rate.
  
  
  RESULTS
  A total of 218 elective PCI patients were randomized into a bivalirudin group (n = 110) and heparin group (n = 108). Except for two patients needing additional dosing in the heparin group, the ACT values of all other patients in both groups were longer than 225 seconds at 5 minutes after the first intravenous bolus. Procedural success rates were respectively 100.0% and 98.2% in the bivalirudin group and heparin group (P > 0.05). Survival rates without major adverse cardiac events at 30 days after PCI were 100.0% in the bivalirudin group and 98.2% in the heparin group (P > 0.05). Mild bleeding rates were 0.9% and 6.9% (P < 0.05) at 24 hours, and 1.9% and 8.8% (P < 0.05) at 30 days after PCI in the bivalirudin group and heparin group respectively. There was one severe gastrointestinal bleeding case in the heparin group.
  
  
  CONCLUSIONS
  Domestic bivalirudin is an effective and safe anticoagulant during elective PCI procedures. The efficacy is not inferior to heparin, but the safety is superior to heparin.
authors: Cardiovascular Department, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China. dcxiang@foxmail.com
authors: Ding-cheng
authors: DC
authors: Xiang
authors: Xiao-long
authors: XL
authors: Gu
authors: Yao-ming
authors: YM
authors: Song
authors: Wei-jian
authors: WJ
authors: Huang
authors: Liang-qiu
authors: LQ
authors: Tang
authors: Yao-hui
authors: YH
authors: Yin
authors: Shao-hua
authors: SH
authors: Geng
authors: Hao
authors: H
authors: Zhou
authors: Wen-mao
authors: WM
authors: Fan
authors: Rong
authors: R
authors: Hu
authors: Chun-mei
authors: CM
authors: Pan
authors: Yi
authors: Y
authors: Zhang
authors: Fang-yi
authors: FY
authors: Xiao
authors: Huai-bin
authors: HB
authors: Wan
authors: Zeng-zhang
authors: ZZ
authors: Liu
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects; 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; D016037:Single-Blind Method; D015996:Survival Rate; D014914:Whole Blood Coagulation Time
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin