Heparin Beats Bivalirudin in Primary PCI

By Larry Husten

Edited by David G. Fairchild, MD, MPH, and André Sofair, MD, MPH

Bivalirudin is associated with a higher rate of major adverse cardiac events than heparin in patients with myocardial infarction undergoing primary percutaneous coronary intervention, according to a Lancet study.

Roughly 1800 patients undergoing primary PCI were randomized to either heparin or bivalirudin. There was a significant increase in the primary efficacy outcome — a composite of death, stroke, reinfarction, or unplanned target lesion revascularization at 28 days — in the bivalirudin group, compared with the heparin group (8.7% vs. 5.7%). There was no significant difference in the incidence of major bleeding. The use of bailout glycoprotein (GP) IIb/IIIa inhibitors was similar in both groups, roughly 15%.

Editorialists write that the difference in findings between the HEAT-PPCI trial and earlier trials can be explained by several factors, including the lower use of GP IIb/IIIa inhibitor in conjunction with heparin in HEAT-PPCI, the use of higher doses of heparin in previous studies, and the greater use of radial access in HEAT-PPCI. The trial, they write, "provides strong evidence that bivalirudin alone compared with 70 U/kg of heparin alone (with infrequent bailout use of GP IIb/IIIA inhibitors in both arms), with radial access for STEMI percutaneous coronary intervention, seems to be inferior to heparin as administered in this trial."

Adapted from CardioExchange