Original Title: Bivalirudin Is Associated with Improved In-Hospital Outcomes Compared with Heparin in Percutaneous Vascular Intervention. Observational, Propensity –Matched Analysis From the Premier Hospital Database. Reference: Carey Kimmeslstiel, et al. Circ Cardiovasc Interv. 2016 Jan;9(1).
Courtesy of Dr. Carlos Fava
Lower limb vascular interventions are increasing in number and bleeding is one of its most frequent complications. One alternative is to use bivalirudin as anticoagulant, though the information currently available is not enough.
This is a retrospective observational study based on the Premier Hospital database (>600 hospitals in US), including 33,558 patients undergoing peripheral PCI with bivalirudin or unfractionated heparin as procedural anticoagulation.
Primary end point was the combination of death, MI, need for transfusion, stroke and amputation. Secondary end point was net adverse clinical events.
In the general population, those receiving bivalirudin were older, more frequently men, hypertensive, diabetic and obese; on the other hand, those receiving heparin presented more anemia, heart failure, and critical limb ischemia.
After propensity score was used to match baseline characteristics, 3649 patients remained in each group.
Bivalirudin was associated with a reduction of in-hospital rates such as mortality (OR 0.40; p=0.017) and the need for transfusion (OR, 0.74 p= 0.009), as well as cardiovascular adverse events (OR, 0.64; p=0.003) and net clinical adverse events (OR, 0.74 p=<0.001).
These differences were maintained in all different subgroups.
In multivariable analysis, bivalirudin was associated to a reduction of the combined end point, mortality, transfusion and amputation.
In the group receiving rescue glycoprotein inhibitors, a significant reduction of events was also observed with bivalirudin.
Conclusion
In patients receiving peripheral PCI, anticoagulation with bivalirudin could be associated to a reduction of adverse events compared to unfractionated heparin. These observations require further confirmation in randomized controlled studies.
Editorial Comment
Even though this analysis presents a few limitations, it is the largest to show important benefits of bivalirudin in the context of peripheral vascular interventions. The need of glycoprotein inhibitors does not hinder its beneficial effects.
To confirm these findings, we need further research in randomized studies to explore its real benefits, given its cost.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Buenos Aires.