Bivalirudin safer than heparin in patients with chronic total occlusion

Patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) may fare better with bivalirudin than with unfractionated heparin (UFH), with a study showing that although the two drugs exhibit comparable efficacy, the former delivers superior safety.

The retrospective analysis used data from 736 patients with CTO who underwent PCI and treated with either bivalirudin or UFH. Of the patients, 71.5 percent had the radial approach. There were no significant differences in the majority of baseline characteristic between the two treatment groups.

The primary safety endpoint of 30-day incidence of net adverse clinical events (NACEs) was significantly lower in the bivalirudin than the UFH group (12.9 percent vs 21.5 percent; p=0.002). Major bleeding also occurred less frequently among patients treated with bivalirudin (2.5 percent vs 8.0 percent; p=0.001).

Meanwhile, major adverse cardiovascular events (MACEs), which assessed efficacy, did not differ between the two treatment groups. The same was true for other endpoints, including myocardial infarction, death, stroke, stent thrombosis, and target vessel revascularization.

Bivalirudin as a thrombin inhibitor has been associated with a low risk of bleeding during PCI, with some evidence pointing to comparable effectiveness and safety between the drug and UFH. However, the present data suggest that using bivalirudin during PCI offers better safety to patients with CTO, mostly via radial access.