The HORIZONS-AMI and EUROMAX studies, had already shown that bivalirudin is superior to heparin plus inhibitors IIB / IIIA glycoprotein in reducing adverse clinical events in patients suffering an ST-segment elevation myocardial infarction undergoing primary angioplasty, at the expense of increase in the rate of acute stent thrombosis. This study included 2194 patients undergoing an acute myocardial infarction, randomized to heparin alone (n = 729), heparin plus tirofiban (n = 730) and bivalirudin alone (n = 735). Almost 80% of patients received radial access.
At 30 days and one year, the combined death end point, re-infarction, target vessel revascularization, stroke or bleeding events was significantly reduced with bivalirudin versus heparin versus heparin plus tirofiban (8.8% versus 17% versus 13.2%, P <0.001). For safety end points such as stent thrombosis and thrombocytopenia no differences at 30 days between groups were observed.
Conclusion
In patients with acute myocardial infarction undergoing primary angioplasty, treatment with bivalirudin was superior to both single heparin and heparin associated with tirofiban. The rates of acute, subacute, and late thrombosis were similar between groups.
Yaling Han
2014-09-16
Original title: A Prospective, Randomized Trial of Bivalirudin Monotherapy Versus Heparin Monotherapy Versus Heparin Plus Tirofiban in Patients with Acute Myocardial Infarction Undergoing Coronary Intervention.
