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Original research article
Bivalirudin versus heparin in primary PCI: clinical outcomes and cost analysis
  1. Pierre Deharo1,2,
  2. Thomas W Johnson1,
  3. Hazim Rahbi1,
  4. Raveen Kandan1,
  5. Ruth Bowles1,
  6. Abdul Mozid1,
  7. Stephen Dorman1,
  8. Julian W Strange1 and
  9. Andreas Baumbach1,3
  1. 1Cardiology, Bristol Heart Institute, Bristol, UK
  2. 2Hopital la Timone, Marseille, France
  3. 3Barts Health NHS Trust, London, UK
  1. Correspondence to Professor Andreas Baumbach; baumbach.andreas{at}


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.

  • primary pci
  • heparin
  • bivalirudin

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  • Contributors PD, HR, RK, RB, AM and JWS report no conflict of interest. TWJ reports lecture and advisory fees from AstraZeneca, Daiichi Sankyo, advisory fees from Correvio and research and lecture fees from The Medicines Co. AB reports speaker fees from the Medicines Company and Abbott Vascular.

  • Funding This work was supported by Bristol Heart Institute.

  • Competing interests TWJ reports Lecture and advisory fees from AstraZeneca, Daiichi Sankyo, advisory fees from Correvio, and research and lecture fees from The Medicines Co. AB reports speaker fees from the Medicines Company and Abbott Vascular.

  • Patient consent Not required.

  • Ethics approval The authors honoured the ethical principles for medical research involving human subjects as set out in the Declaration of Helsinki. They obtained clearance and approval from their institution’s audit committee to use the data for this purpose. The data management and statistical analysis were performed by the research and development section, Bristol Heart Institute, Bristol, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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