RT Journal Article
SR Electronic
T1 Bivalirudin versus heparin in primary PCI: clinical outcomes and cost analysis
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000767
DO 10.1136/openhrt-2017-000767
VO 5
IS 1
A1 Pierre Deharo
A1 Thomas W Johnson
A1 Hazim Rahbi
A1 Raveen Kandan
A1 Ruth Bowles
A1 Abdul Mozid
A1 Stephen Dorman
A1 Julian W Strange
A1 Andreas Baumbach
YR 2018
UL http://openheart.bmj.com/content/5/1/e000767.abstract
AB Background The evidence for benefits of bivalirudin over heparin has recently been challenged. We aimed to analyse the safety and cost-effectiveness following reintroduction of heparin instead of bivalirudin as the standard anticoagulation for primary percutaneous coronary intervention (PPCI) in a high-volume centre.Methods and results This analysis was an open-label, prospective registry including all patients admitted to our centre for PPCI from April 2014 to April 2016. Heparin was reintroduced as standard anticoagulant in April 2015. During the 2 years, 1291 patients underwent a PPCI, 662 in the Bivalirudin protocol period (Cohort B) and 629 in the Heparin protocol period (Cohort H). Baseline and procedural characteristics were not significantly different, except for a higher use of thromboaspiration and femoral access in the earlier Cohort B. Glycoprotein 2b3a (Gp2b3a) antagonists were used in 24% of the patients in Cohort B versus 28% in Cohort H (P<0.01). We did not observe any differences in death at 180 days (11.03% in Cohort B vs 11.29% in Cohort H)(HR 95% CI 0.98 (0.72 to 1.33), P=0.88). The incidence of any bleeding complications at 30 days did not differ between the two periods (21.9% vs 21.9%, P=0.99). The cost related to the anticoagulants amounted to £246 236 in Cohort B versus £4483 in Cohort H (£324 406 vs £102 347 when adding Gp2b3a antagonists).Conclusion We did not find clinically relevant changes in patient outcomes, including bleeding complications with reintroduction of heparin in our PPCI protocol. However, the use of heparin was associated with a major reduction in treatment costs.