Bivalirudin vs Heparin and GPIs in STEMI Patients Having PCI
The present pooled patient-level analysis from the large-scale, multicenter, prospective, randomized HORIZONS-AMI and EUROMAX trials demonstrates that despite evolution in PCI practice, technique, and adjunct pharmacology, anticoagulation during primary PCI with bivalirudin compared with heparin ± GPI reduces the 30-day rates of cardiac mortality, major and minor bleeding, thrombocytopenia, and transfusions at the cost of an increase in acute stent thrombosis. These results support the use of bivalirudin for anticoagulation of patients with STEMI undergoing primary PCI, independently of vascular access site, choice of P2Y12 inhibitor, and timing of drug initiation and discontinuation.
Conclusions
The present pooled patient-level analysis from the large-scale, multicenter, prospective, randomized HORIZONS-AMI and EUROMAX trials demonstrates that despite evolution in PCI practice, technique, and adjunct pharmacology, anticoagulation during primary PCI with bivalirudin compared with heparin ± GPI reduces the 30-day rates of cardiac mortality, major and minor bleeding, thrombocytopenia, and transfusions at the cost of an increase in acute stent thrombosis. These results support the use of bivalirudin for anticoagulation of patients with STEMI undergoing primary PCI, independently of vascular access site, choice of P2Y12 inhibitor, and timing of drug initiation and discontinuation.