Anticoagulation with bivalirudin vs heparin yields similar efficacy outcomes in NSTEMI

In patients with non–ST-segment–elevation myocardial infarction (NSTEMI), the rates of mortality and ischaemic events appear to be comparable following procedural anticoagulation with bivalirudin vs heparin, although bivalirudin is associated with fewer serious bleeding events, according to the results of a meta-analysis.

For the meta-analysis, researchers used individual patient data from five trials (MATRIX, VALIDATE-SWEDEHEART, ISAR-REACT 4, ACUITY, and BRIGHT) that involved NSTEMI patients who underwent percutaneous coronary intervention (PCI).

The pooled population comprised 12,155 patients, of which 6,040 had been randomized to bivalirudin (52.3 percent with a post-PCI bivalirudin infusion) and 6,115 to heparin (53.2 percent with planned glycoprotein IIb/IIIa inhibitor use). The primary effectiveness and safety endpoints were 30-day all-cause mortality and serious bleeding, respectively.

No significant difference in 30-day mortality was seen between bivalirudin and heparin (1.2 percent vs 1.1 percent; adjusted odds ratio [aOR], 1.24, 95 percent confidence interval [CI], 0.86–1.79; p=0.25). Likewise, similar rates were seen for cardiac mortality, reinfarction, and stent thrombosis.

Compared with heparin, bivalirudin led to significantly lower rates of serious bleeding, both access site- and nonaccess site-related (3.3 percent vs 5.5 percent; aOR, 0.59, 95 percent CI, 0.48–0.72; p<0.0001).

Results were similar, regardless of use of a post-PCI bivalirudin infusion or routine lycoprotein IIb/IIIa inhibitor use with heparin and during 1-year follow-up.