BIVALIRUDIN COMPARED WITH HEPARIN DURING CORONARY ANGIOPLASTY FOR THROMBUS-CONTAINING LESIONS

Objectives. We investigated whether bivalirudin is more effective than heparin in preventing ischemic complications in high risk patients un dergoing coronary angioplasty for thrombus-containing lesions detected by angiography. Background. Heparin is administered during coronary a ngioplasty to prevent closure of the dilated vessel. Bivalirudin (Hiru log) is a direct thrombin inhibitor that can be safely substituted for heparin during angioplasty. Bivalirudin has several theoretic advanta ges over heparin as an anticoagulant agent. Methods. We performed an o bservational analysis of the Hirulog Angioplasty Study in which 4,098 patients with unstable or postinfarction angina were randomized to rec eive either bivalirudin or heparin during coronary angioplasty, The st udy group for this analysis consisted of 567 patients who had thrombus -containing lesions on angiography. The primary end point was death, m yocardial infarction, emergency coronary artery bypass graft surgery o r abrupt vessel closure before hospital discharge. Results. Patients w ith thrombus containing lesions had a higher incidence of myocardial i nfarction (5.1% vs. 3.2%, p = 0.03) and abrupt vessel closure (13.6% v s, 8.3%, p < 0.001) than those without thrombus. In patients with thro mbus containing lesions, however, the incidence of the primary end poi nt was not different between the bivalirudin and heparin treatment gro ups. Furthermore, no difference in the incidence of ischemic events at 6 months was seen between the treatment groups. Conclusions. Bivaliru din is not more effective than heparin in preventing ischemic complica tions in patients undergoing coronary angioplasty for thrombus-contain ing lesions detected by angiography. Other approaches, perhaps involvi ng potent antiplatelet agents, should be considered for patients with thrombus-containing lesions. (C) 1997 by the American College of Cardi ology.