Okay to Switch from Heparin to Bivalirudin Before Primary Percutaneous Coronary Intervention

In patients taking unfractionated heparin at baseline, those who switched did as well as — or better than — those who remained on UFH with an added glycoprotein IIb/IIIa inhibitor.

In the industry-sponsored HORIZONS-AMI trial, investigators compared bivalirudin with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibition for antithrombosis during primary percutaneous coronary intervention (PCI; JW Cardiol May 21 2008). In this subanalysis, the effects of switching agents were assessed in the 2357 patients who had received UFH before randomization. Most (82%) received bolus-only UFH (about 5000 IU, on average) about 1 hour before study drug administration.

Compared with patients assigned to remain on UFH, those assigned to bivalirudin (switch group) had lower rates of major bleeding, non–coronary-artery-bypass-grafting (non-CABG)-related major bleeding, TIMI (thrombolysis in myocardial infarction) major bleed…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI