Bivalirudin reduced mortality and bleeding compared to heparin and glycoprotein IIbIIIa in HORIZONS- AMI study. However there was a higher rate of acute stent thrombosis in patients receiving bivalirudin. This randomized study (> 90 % randomized in the ambulance) enrolled 2218 patients with ASTEMIto prolonged infusion of bivalirudin compared with heparin -associated glycoprotein inhibitors. The primary objective of the study was a composite of death, bleeding, and revascularization at 30 days.The use of clopidogrel was balanced with new antiplatelet drugs and 50 % received radial access. Bivalirudin significantly reduced the primary end point (5.1 % versus 8.4 %, p = 0.002). Reduction in death, infarction and bleeding was nearly 25%. The rate of in-stent thrombosis in the first 48 % continued to be higher for bivalirudin group (p = .02).
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Philippe Gabriel Steg
2013-10-30
Original title: EUROMAX: A Prospective, Randomized Trial of Ambulance Initiation of Bivalirudin vs. Heparin ± Glycoprotein IIb/IIIa Inhibitors in Patients with STEMI Undergoing Primary PCI
