Chang LIU, En-rui XIE, Yi-xuan DUAN, Ya-juan NI, Qing LI, Deng-feng GAO, Jie DENG. Efficacy and safety of bivalirudin in treatment of acute coronary syndrome patients during perioperative period of percutaneous coronary intervention[J]. Chinese Heart Journal, 2022, 34(4): 413-416, 421. DOI: 10.12125/j.chj.202108035
    Citation: Chang LIU, En-rui XIE, Yi-xuan DUAN, Ya-juan NI, Qing LI, Deng-feng GAO, Jie DENG. Efficacy and safety of bivalirudin in treatment of acute coronary syndrome patients during perioperative period of percutaneous coronary intervention[J]. Chinese Heart Journal, 2022, 34(4): 413-416, 421. DOI: 10.12125/j.chj.202108035

    Efficacy and safety of bivalirudin in treatment of acute coronary syndrome patients during perioperative period of percutaneous coronary intervention

    •   AIM  To investigate the efficacy and safety of bivalirudin in acute coronary syndrome (ACS) patients during the perioperative period of percutaneous coronary intervention (PCI).
        METHODS  A retrospective analysis was conducted in 309 PCI patients who received aspirin plus ticagrelor as antiplatelet pretreatment from January 2018 to June 2020 in the First and Second Affiliated Hospital of Xi’an Jiaotong University. According to antithrombotic therapy during perioperative period of PCI, the patients were divided into two groups: the bivalirudin group and the heparin plus Gp IIb/IIIa inhibitor (GPI) group. Based on the clinical and demographic variables, 1∶1 propensity score matching was conducted and the patients were followed up by phone. The primary endpoint was 30-day net adverse clinical event (NACE), defined by any bleeding as defined by the Bleeding Academic Research Consortium (BARC) and a composite of major adverse cardiac or cerebral events (MACCE), including all-cause death, urgent ischemia-driven target vessel revascularization (uTVR), reinfarction and stroke. The secondary endpoints were 30-day and 6-month MACCE and any bleeding, as well as 6-month NACE.
        RESULTS  Among the 309 patients who underwent PCI, 58 patients were assigned to the bivalirudin group and 251 patients to heparin plus GpⅡb/Ⅲa inhibitor group. After propensity score matching, each of the two groups included 50 patients respectively. No statistical difference was found between the two groups in the incidence of 30-day NACE, MACCE, any bleeding and 6-month NACE, MACCE and all bleeding. Nor was the difference found in the incidence of 30-day BARC3-5 . However, the risk of 30-day NACE was found to have reduced in bivalirudin-treated medium-to-high bleeding risk ACS patients with >30 scores ranked by the CRUSADE bleeding score (Bivalirudin vs. Heparin plus GPI, 0 vs. 6.0%, P<0.05).
        CONCLUSION  Bivalirudin is efficacious and safe in ACS patients after asprin plus ticagrelor combination therapy during the perioperative period of PCI. Bivalirudin reduces the risk of 30-day NACE in ACS patients with medium to high bleeding risk.
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