Anticoagulation with bivalirudin during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) or non-STEMI is associated with similar rates of adverse outcomes to the use of heparin. In the registry-based, open-label VALIDATE-SWEDEHEART trial, 3,005 patients with STEMI and 3,001 patients with non-STEMI were randomly assigned to bivalirudin or heparin during PCI (predominantly radial access). Patients also received a potent P2Y12 inhibitor and were not intended to receive a glycoprotein IIb/IIIa inhibitor. After 180 days, the primary end point (all-cause mortality, myocardial infarction, or major bleeding) occurred in 12.3% and 12.8% of the bivalirudin and heparin groups, respectively. “Even after VALIDATE-SWEDEHEART, there is no definitive answer to the question of whether to use bivalirudin or heparin during PCI,” comments Gregg Stone in an editorial accompanying the trial report, but forthcoming meta-analyses are designed to resolve this question.
References
Erlinge, D. et al. Bivalirudin versus heparin monotherapy in myocardial infarction. N. Engl. J. Med. http://dx.doi.org/10.1056/NEJMoa1706443 (2017)
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Lim, G. Bivalirudin not superior to heparin in PCI. Nat Rev Cardiol 14, 632 (2017). https://doi.org/10.1038/nrcardio.2017.142
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DOI: https://doi.org/10.1038/nrcardio.2017.142