title: Comparison of Safety and Efficacy of Unfractionated Heparin Versus Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Anti-platelet and anti-coagulant adjunctive therapies are associated with a clinically significant increased risk of major bleeding. We retrospectively assessed in-hospital major adverse clinical events (MACE) and major bleeding in patients undergoing percutaneous coronary intervention (PCI) who received either unfractionated heparin (UFH) or bivalirudin.
  
  
  METHODS
  Consecutive patients undergoing PCI for acute coronary syndrome (ACS) at Fremantle Hospital from August 2008 to December 2013 were identified. Patients received dual antiplatelet therapy (DAPT), with either UFH (50-100IU/kg) or bivalirudin (bolus 0.75mg/kg and infusion 1.75mg/kg/hr). Adjunctive glycoprotein IIb/IIIa (GPIIbIIIa) antagonist use was at the operator's discretion. In-hospital events were identified from case notes and PCI database review.
  
  
  RESULTS
  Of 3371 patients identified, 1740 received UFH and 1631 received bivalirudin. The two groups were similar with respect to age, 62.5 SD 12.1 yrs vs. 62.8 SD 12.2 yrs, (p=0.575) female gender, 24% vs. 26% (p=0.10), current smokers, 66% vs. 70% (p=0.53), diabetes, 25% vs. 26% (p=0.62) and the use of DAPT (p=ns). Presentation with ST-segment-elevation myocardial infarction (STEMI) was significantly higher in the UFH group (28% vs. 19%, p<0.001). The use of transfemoral arterial access was similar (93% UFH vs. 92% bivalirudin) (p=0.41). More patients received GPIIb/IIIa antagonist in the UFH group (30% vs. 3%; p <0.001). There was no difference in pre-discharge acute stent thrombosis (<24hours) occurring in 1.0% with UFH vs. 0.5% with bivalirudin (p=0.20). The equipoise on the outcomes of stent thrombosis persisted after multivariate adjustment for difference in rates of STEMI. In-hospital BARC Type 1-3 major bleeding occurred in 3.7% in the UFH group vs. 2.9% in the bivalirudin group (p=0.20).
  
  
  CONCLUSIONS
  Unfractionated heparin compared with bivalirudin was not associated with a higher incidence of in-hospital MACE or major bleeding in a cohort with overall high rates of transfemoral access, despite significantly higher use of GPIIb/IIIa antagonists in the UFH group.
authors.affiliation: Department of Cardiology, Fremantle Hospital, Perth, WA, Australia. Electronic address: ahmedukhan@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rehmani
authors.affiliation: Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Judkins
authors.affiliation: Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Whelan
authors.affiliation: Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Department of Cardiology, Fremantle Hospital, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Bare metal stent; Drug-eluting stent; Dual anti-platelet therapy; Major adverse cardiac events; Percutaneous coronary intervention; Unfractionated heparin