Okay to Switch from Heparin to Bivalirudin Before Primary Percutaneous Coronary Intervention

In patients taking unfractionated heparin at baseline, those who switched did as well as — or better than — those who remained on UFH with an added glycoprotein IIb/IIIa inhibitor.

In the industry-sponsored HORIZONS-AMI trial, investigators compared bivalirudin with unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibition for antithrombosis during primary percutaneous coronary intervention (PCI; JW Cardiol May 21 2008). In this subanalysis, the effects of switching agents were assessed in the 2357 patients who had received UFH before randomization. Most (82%) received bolus-only UFH (about 5000 IU, on average) about 1 hour before study drug administration.


Compared with patients assigned to remain on UFH, those assigned to bivalirudin (switch group) had lower rates of major bleeding, non–coronary-artery-bypass-grafting (non-CABG)-related major bleeding, TIMI (thrombolysis in myocardial infarction) major bleeding, transfusion, and thrombocytopenia at 30 days. The switch group also had lower 30-day cardiac mortality (1.6% vs. 2.9%) and a lower rate of major adverse cardiac events or non–CABG-related major bleeding (8.7% vs. 13.6%). Rates of reinfarction, stroke, and target-vessel revascularization were similar in both groups. The rate of stent thrombosis was higher in the switch group than in the continuation group within 24 hours after PCI (0.8% vs. 0.1%), but it was similar in both groups by 30 days. The benefits of bivalirudin were maintained at 2-year follow-up and were independent of baseline activated clotting time.


Citation(s):

Dangas GD et al. for the HORIZONS-AMI Trial Investigators. Effect of switching antithrombin agents for primary angioplasty in acute myocardial infarction: The HORIZONS-SWITCH analysis. J Am Coll Cardiol 2011 Jun 7; 57:2309.