Bivalirudin could be beneficial in peripheral PCI

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.

More articles by this author

TCT 2024 | SIRONA: Randomized Study Comparing Sirolimus-Coated vs Paclitaxel-Coated Balloon Angioplasty in Femoropopliteal Disease

This prospective, randomized, multicenter, investigator-initiated non-inferiority study compared the use of sirolimus-coated balloon (MagicTouch) vs paclitaxel-coated balloon in endovascular treatment.  The primary objective was to...

TCT 2024 | PEERLESS: Mechanical Thrombectomy with FlowTriever vs Catheter-Directed Thrombolysis in Intermediate Risk PTE

Pulmonary embolism (PE) continues to be the third cause of cardiovascular mortality. The current clinical guidelines recommend anticoagulation in intermediate risk patients presenting right...

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...