Bivalirudin versus heparin in patients planned for coronary stenting

August 15, 2014 11:01 PM

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Boston, MA— Bivalirudin and heparin are two anticoagulant options for patients undergoing coronary stenting for ischemic heart disease. Bivalirudin, a newer anticoagulant, has been touted as being as effective as generic heparin, but with nearly half the rate of bleeding. However, several studies have hinted that, compared with heparin, bivalirudin-based regimens might not protect as well against recurrent heart attacks and might increase the risk of stents clotting off. Moreover, newer studies have questioned whether the reduction in bleeding holds up when tested on more modern background therapy. Researchers from Brigham and Women's Hospital (BWH) conducted an analysis of all of the previous trials to date to better define both the benefits and risks of the competing anticoagulants. They found that, compared with heparin-based regimens, bivalirudin-based regimens increased the risk of heart attack and stent thrombosis. Bivalirudin-based regimens decreased the risk of bleeding, but by how much depended on whether other blood thinners were used more with heparin than with bivalirudin. These findings are published in The Lancet on August 15, 2014.

"Our study found that using a bivalirudin-based regimen increased the risk of major adverse cardiac events by nine percent. This risk was largely driven by an increased risk of heart attack and recurrent angina requiring further coronary stenting. There was also more than a four-fold increase in the...

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