21 May Anticoagulation With Bivalirudin vs Heparin for STEMI treated with PCI: Pros and Cons of Each
MedicalResearch.com Interview with:
Dr. Ion S. Jovin, MD, ScD
Associate Professor of Medicine at Virginia Commonwealth University Pauley Heart Center
Director of the Cardiac Catheterization Laboratories and
Site Director of the VCU Interventional Cardiology Fellowship Program at
McGuire V.A. Medical Center
Visiting Assistant Professor in the Department of Surgery/Cardiothoracic Surgery
Yale University, New Haven, CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is still uncertainty regarding the best anticoagulant for patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) and especially PCI done via radial (as opposed to femoral) access. Our study compared outcomes of patients with STEMI treated with PCI done via radial access in the NCDR database who received one of the two main anticoagulants: bivalirudin and heparin. There is a large degree of variation in the use of the two anticoagulants in PCI and in primary PCI both within the United States but also in the world.
We did not find a statistically significant difference between the outcomes of the two groups of patients, but we also found that a significant number of patients in both the heparin and in the bivalirudin group were also treated with additional medicines that inhibit platelet activation (glycoprotein IIb/IIIa inhibitors).
MedicalResearch.com: What should readers take away from your report?
Response: That in all likelihood the two anticoagulants as used in real world practice are about the same but each has its advantages and its disadvantages (for instance one is easier to use and the other one is cheaper). However, because our study was a retrospective analysis, our results can only be hypothesis-generating.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Our findings add further evidence that in contemporary practice and when primary PCI is performed via the radial access, the improved outcomes seen with bivalirudin in the previous decade are unlikely to be replicated. However, the question needs to be settled in a large randomized controlled trial of patients with STEMI treated with PCI done via radial access.
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Ion S. Jovin, Rachit M. Shah, Dhavalkumar B. Patel, Sunil V. Rao, Dmitri V. Baklanov, Issam Moussa, Kevin F. Kennedy, Eric A. Secemsky, Robert W. Yeh, Michael C. Kontos, George W. Vetrovec. Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Via Radial Access Anticoagulated With Bivalirudin Versus Heparin. JACC: Cardiovascular Interventions, 2017; DOI: 10.1016/j.jcin.2017.03.021
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