Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization : A real world experience.
BACKGROUND
In a retrospective analysis of a prospective single center registry we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) undergoing stent implantation.


RESULTS
Bivalirudin was associated with tendentially reduced in-hospital minor or major bleeding rates compared to UFH monotherapy (5.9 % vs. 9.4 % adjusted odds ratio (OR) 0.82, 95 % confidence interval CI 0.45-1.51, p = 0.53) and compared to the pooled UFH group (5.9 % vs. 11.9 %, adjusted OR 0.62, 95 % CI 0.36-1.08, p = 0.09) but with significantly lower bleeding hazards compared to UFH + abciximab (5.9 % vs. 16 %, adjusted OR 0.41, 95 % CI 0.22-0.78, p < 0.01). After 3 years of follow-up, adjusted cardiovascular mortality rates were similar between all groups, particularly between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95 % CI 0.58-2.16, p = 0.73) and vs. UFH + abciximab (HR 0.91, 95 % CI 0.40-2.10, p = 0.83). Acute or subacute stent thrombosis occurred at a rate of 0.8 % with no significant differences between the groups.


CONCLUSIONS
This retrospective analysis in a real world situation of medium to high-risk ACS patients undergoing invasive revascularization confirmed the results of most large-scale randomized trials by demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but with no significant differences between treatment strategies for long-term all-cause and cardiovascular mortality.
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria. miklos.rohla@meduniwien.ac.at.
Miklos
http://orcid.org/0000-0002-8967-0806
M
Rohla
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Ioannis
I
Tentzeris
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Matthias K
MK
Freynhofer
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Serdar
S
Farhan
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Rudolf
R
Jarai
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Florian
F
Egger
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.|Medical School, Sigmund Freud University, Vienna, Austria.
Thomas W
TW
Weiss
Department of Cardiology, Medical University, Vienna, Austria.
Johann
J
Wojta
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.
Alexander
A
Geppert
Deutsches Herzzentrum, Technische Universität, Munich, Germany.
Adnan
A
Kastrati
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, USA.
Gregg W
GW
Stone
3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria.|Medical School, Sigmund Freud University, Vienna, Austria.
Kurt
K
Huber
D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D000991:Antithrombins / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006629:Hirudins / Q000008:administration & dosage*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
Acute coronary syndrome; Anticoagulation; Bivalirudin; Heparin; Percutaneous coronary intervention