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Unfractionated heparin administration in patients treated with bivalirudin during primary percutaneous coronary intervention is associated lower mortality and target lesion thrombosis: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
  1. Michael Koutouzis1,
  2. Bo Lagerqvist2,
  3. Stefan James2,
  4. Elmir Omerovic1,
  5. Göran Matejka1,
  6. Lars Grip1,
  7. Per Albertsson1
  1. 1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
  2. 2Department of Cardiology and Uppsala Clinical Research Centre, Uppsala University Hospital/Uppsala University, Uppsala, Sweden
  1. Correspondence to Michael Koutouzis, Department of Cardiology, Sahlgrenska University Hospital, 4 Bruna straket, 41345 Gothenburg, Sweden; koutouzismike{at}yahoo.gr

Abstract

Background Bivalirudin reduces bleeding events and is associated with a lower mortality than the combination of unfractionated heparin (UFH) and glycoprotein IIb/IIIa inhibitor during primary percutaneous coronary intervention (PCI). However, the effect of adding UFH in patients with ST elevation myocardial infarction (STEMI) treated with bivalirudin during primary PCI is unknown.

Methods Patients enrolled in the national Swedish Coronary Angiography and Angioplasty Registry who underwent primary PCI due to STEMI with bivalirudin as anticoagulant were evaluated. Patients were divided into two groups: those treated with bivalirudin only and those treated with bivalirudin plus a bolus dose of UFH.

Results 2996 patients were included in the study: 1928 (64%) received only bivalirudin and 1068 (36%) received bivalirudin plus a bolus dose of UFH. The primary combined endpoint of death or target lesion thrombosis at 30 days occurred more often in the bivalirudin group (11.3% vs 6.5%, OR 0.55, 95% CI 0.41 to 0.72, p<0.001). This difference remained significant after adjustment (HR 0.64, 95% CI 0.44 to 0.95, p=0.03). Death at 30 days and definite target lesion thrombosis at 30 days did not differ between the two groups after adjustment (9.2% vs 5.1%, adjusted HR 0.66, 95% CI 0.42 to 1.03, p=0.07 and 2.3% vs 1.5%, adjusted HR 0.59, 95% CI 0.27 to 1.33, p=0.21, respectively).

Conclusion An additional bolus dose of UFH is associated with a lower rate of death or definite target lesion thrombosis at 30 days in patients undergoing primary PCI with bivalirudin as anticoagulant.

  • Coronary angioplasty (PCI)
  • anticoagulation

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Footnotes

  • See Editorial, p 1459

  • Competing interests None.

  • Ethics approval This study was performed according to the rules of the Declaration of Helsinki. The participation of the patients in the registry was approved by all hospital ethics committees and informed consent was obtained from all patients before entering their data in the registry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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