News | Antiplatelet and Anticoagulation Therapies | August 16, 2017

Meta-Analysis Evaluates the Effect of Post-PCI Bivalirudin on Adverse Clinical Events

Bivalirudin exhibited an improvement in 30-day all-cause mortality when injected post PCI.

August 16, 2017 — A study has examined the efficacies of various post-percutaneous coronary intervention (PCI) bivalirudin doses on net adverse clinical events (NACEs) and mortality. Patients recovering from PCI with bivalirudin are at a lower risk of bleeding, but also suffer an increased risk of acute stent thrombosis (ST). Bivalirudin is a direct thrombin inhibitor that can prevent blood clots during and after an angioplasty procedure. Previous research concluded that continuing bivalirudin infusion at full doses for four hours post-PCI eliminates acute ST risk while maintaining the bleeding benefit. The results of the current study determined that full-dose bivalirudin infusion post-PCI for four hours is also associated with improved NACEs and all-cause mortality. Details of the entire study are outlined in the Editor’s Choice article of the August 2017 issue of Catheterization and Cardiovascular Interventions.  

Researchers analyzed randomized-clinical trials (RCTs) to gather results. The data was separated into two groups: (1) patients treated with bivalirudin and (2) patients treated with unfractionated heparin (UFH). The bivalirudin arm was divided based on post-PCI bivalirudin dosage; The Biv-Full group received 1.75 mg/kg/h, the BivLow group, 0.25 mg/kg/h and the Biv-No group, none.  

“For many years, heparin was the only anticoagulant available for primary PCI,” said Rahman Shah, M.D., FSCAI, of the division of cardiovascular medicine at the University of Tennessee Health Science Center. “However, once a lower risk of bleeding was found with bivalirudin, many cardiologists started using it preferentially over heparin. Once the acute stent thrombosis risk with bivalirudin was well-publicized, many physicians returned to using heparin. With this research, we show that for patients undergoing primary PCI, bivalirudin [with four-hour post-PCI infusion at full dose] might be the safest and most effective anticoagulation because it is associated not only with decreased risk of bleeding and net adverse clinical event events, but also improved mortality.”

Six RCTs and 16,842 patients met the criteria for inclusion. Bivalirudin exhibited an improvement in 30-day all-cause mortality by 35 percent and cardiac mortality by 32 percent, but did not yield a NACE rate better than that achieved with UFH. Subgroup analysis showed the Biv-Full group had a 46 percent lower NACE rate and 47 percent lower all-cause mortality than UFH. These effects were not seen in the other two groups. The Biv-Full group yielded the best treatment efficacy overall.

“Our findings are consistent with recent changes to the bivalirudin package insert by the FDA,” Shah continued. “Therefore, if bivalirudin-based anticoagulation is used during primary PCI, it should be continued for at least four hours [at full dose] post-PCI. Ongoing trials such as SWEDEHEART (NCT02311231), which mandates full-dose bivalirudin post-PCI in patients with acute coronary syndrome, will provide additional insights into this topic.”

The authors of “Effect of Post-Primary Percutaneous Coronary Intervention Bivalirudin Infusion on Net Adverse Clinical Events and Mortality: A Comprehensive Pairwise and Network Meta-Analysis of Randomized Controlled Trials” include Rahman Shah, M.D., FSCAI; Khalid Matin, M.D.; Kelly C. Rogers, Pharm.D; and Sunil V. Rao, M.D., FSCAI.

For more information:

Related Bivalirudin Content:

No Difference Adverse Events When Comparing Anticoagulants

Study Finds Blood Clot Prevention Medications Equally Safe and Effective for PCI Patients

Analysis Shows Increased Risk of Early Stroke with New-Onset Atrial Fibrillation Post-TAVR


Related Content

Videos | Angiography| November 22, 2017
Shimadzu demonstrated its Trinias Interventional X-ray System at the 2017 Transcatheter Cardiovascular Therapeutics (
Videos | Radial Access| November 22, 2017
Mladen I.
Avinger Receives 510(k) Clearance for Pantheris Image-Guided Atherectomy Device Modifications
Technology | Atherectomy Devices| November 20, 2017
November 20, 2017 — Avinger Inc. announced in October that the company received 510(k) clearance from the U.S.
Surgery Could Reduce Frailty in Adults With Heart Failure
News | Heart Failure| November 17, 2017
November 17, 2017 — Common practice, and recently published research, shows that the risk of complications with surge
Videos | 3-D Printing| November 17, 2017
Dee Dee Wang, M.D., Director, Structural Heart Imaging at Henry Ford Hospital, Detroit, explains how her center uses
News | Antiplatelet and Anticoagulation Therapies| November 16, 2017
Bristol-Myers Squibb Company and Pfizer Inc. released real-world data (RWD) of outcomes associated with direct oral...
SPRINT Trial Data Support New AHA/ACC Hypertension Guidelines
News | Hypertension| November 16, 2017
Findings from a landmark study funded by the National Institutes of Health (NIH) support a key component of the new...
Videos | Stents Bifurcation| November 15, 2017
Philippe Genereux, M.D., co-director of the structural heart program at the Gagnon Cardiovascular Institute at Morris
Videos | TCT| November 15, 2017
DAIC Editor Dave Fornell shows some of the innovations displayed on the expo floor at the 2017 Transcatheter Cardiova
Videos | FFR Technologies| November 15, 2017
A discussion with William Fearon, M.D.
Overlay Init