Antithrombotic Therapy for Primary PCI: Bivalirudin Looks Like a Winner

According to HORIZONS-AMI, the overall benefits of direct thrombin inhibition are still holding strong at 3 years, but late stent thrombosis remains a concern.

In HORIZONS-AMI, an industry-funded, prospective, open-label, randomized, international trial of bivalirudin versus unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (UFH+GPI) in 3602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI), bivalirudin was associated with reductions in major bleeding and mortality and enhanced event-free survival at 30 days and 1 year (JW Cardiol May 21 2008). Now, the HORIZONS-AMI investigators report the 3-year outcomes (data available on 92% of participants).

Use of dual antiplatelet therapy beyond 1 year was infrequent. Compared with UFH+GPI recipients, bivalirudin recipients had significantly lower rates of all-cause mortali…

Reviewing Author

Beat J. Meyer, MD

Disclosures

Leadership positions in professional societiesBern Heart Foundation (President); International Academy of Medicine, Bern, Switzerland (Director)

Beat J. Meyer, MD

Disclosures

Leadership positions in professional societiesBern Heart Foundation (President); International Academy of Medicine, Bern, Switzerland (Director)