Safety and effectiveness of bivalirudin in routine care of patients undergoing percutaneous coronary intervention.

Abstract:

AIMS:To evaluate the effectiveness and safety of bivalirudin as used in routine care. Bivalirudin has been studied as an alternative to heparin plus glycoprotein IIb/IIIa inhibitor (GPI) during percutaneous coronary intervention (PCI). Trials have indicated that bivalirudin is non-inferior to heparin with respect to death and repeat revascularization and may decrease the risk of major bleeds. The use of bivalirudin in routine care has not been evaluated. METHODS AND RESULTS:Using a representative database, we identified 127 185 individuals who underwent inpatient PCI between June 2003 and December 2006 and were administered either bivalirudin plus provisional GPI or the comparator, heparin plus GPI. We estimated relative risks of blood transfusion, repeated PCI, and in-hospital death. The adjusted hazard ratio (HR) for blood transfusion was 0.67 (0.61-0.73); instrumental variable analysis showed an HR of 0.72 (0.12-4.47). We observed a risk of in-hospital death of 0.80% in the bivalirudin group and 2.1% in the heparin group; the adjusted HR was 0.51 (0.44-0.60). CONCLUSION:In our non-randomized study of routine care, we observed a reduction in blood transfusions and in short-term mortality for patients treated with bivalirudin compared with heparin plus GPI. The mortality benefit was more pronounced in our study than in randomized trials.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Rassen JA,Mittleman MA,Glynn RJ,Alan Brookhart M,Schneeweiss S

doi

10.1093/eurheartj/ehp437

subject

Has Abstract

pub_date

2010-03-01 00:00:00

pages

561-72

issue

5

eissn

0195-668X

issn

1522-9645

pii

ehp437

journal_volume

31

pub_type

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