title: Bivalirudin Is Associated With Improved In-Hospital Outcomes Compared With Heparin in Percutaneous Vascular Interventions: Observational, Propensity-Matched Analysis From the Premier Hospital Database.
abstract: BACKGROUND
  Peripheral vascular interventions are increasingly preferred for the treatment of patients with symptomatic peripheral arterial disease because they are associated with similar clinical outcomes and lower morbidity than open surgical procedures. The objective of this study was to assess the comparative effectiveness of procedural anticoagulation with bivalirudin compared with unfractionated heparin in patients undergoing peripheral vascular interventions.
  
  
  RESULTS
  This was a retrospective, observational study using the Premier Hospital administrative database. We examined 23,934 consecutive patients undergoing lower extremity peripheral vascular interventions between January 2008 and December 2012 who were treated with either bivalirudin or unfractionated heparin. In-hospital end points included death, myocardial infarction, transfusion, stroke, amputation, and the composite end points of major adverse cardiovascular events, and net adverse clinical events. Propensity score matching was performed to control for baseline imbalances and yielded 3649 matched pairs. After propensity score matching, patients treated with bivalirudin had lower in-hospital event rates with significantly lower mortality (odds ratio, 0.40; P=0.017), need for blood product transfusion (odds ratio, 0.74; P=0.009), major adverse cardiovascular events (odds ratio, 0.64; P=0.003), and net adverse clinical events (odds ratio, 0.72; P<0.001). These associations were observed consistently across clinically relevant subgroups.
  
  
  CONCLUSIONS
  In patients undergoing peripheral vascular interventions, procedural anticoagulation with bivalirudin may result in more favorable in-hospital outcomes compared with unfractionated heparin, the current standard of care. These observations will require prospective confirmation in a randomized, controlled trial.
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Carey
authors.initials: C
authors.lastname: Kimmelstiel
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Duane
authors.initials: D
authors.lastname: Pinto
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Weintraub
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Weihong
authors.initials: W
authors.lastname: Fan
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Jayne
authors.initials: J
authors.lastname: Prats
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Efthymios N
authors.initials: EN
authors.lastname: Deliargyris
authors.affiliation: From the Cardiac Catheterization Laboratory, Division of Cardiology, Tufts Medical Center, Boston, MA (C.K., A.W.); Beth Israel Deaconess Medical Center, Boston, MA (D.P.); Michigan Heart and Vascular Institute, Ann Arbor (H.D.A.); Icahn School of Medicine at Mount Sinai, New York (G.D.); The Medicines Company, Parsippany, NJ (W.F., J.P., E.N.D.); and Miami Cardiac and Vascular Institute, FL (B.T.K.).
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006629:Hirudins / Q000008:administration & dosage*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: blood transfusion; hemorrhage; heparin; peripheral arterial disease; propensity score