Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel: A propensity-matched study

Martial Hamon, Laurent Bonello, Steven Marso, Sunil V. Rao, Marco Valgimigli, Freek Verheugt, Anthony Gershlick, Yamei Wang, Jayne Prats, Gabriel P. Steg, Efthymios Deliargyris

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Several percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)-based regimens ± glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third-generation oral thienopyridine, has not been previously evaluated. Methods Using the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n = 3377) or HEP ± GPI (n = 3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital-level characteristics, propensity score-matching (PSM) analyses were performed. Results Mortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP ± GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95% confidence interval: 0.34-0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP ± GPI (0.9 ± 2.0 vs 1.2 ± 2.3 days, P < 0.0001). Conclusions In patients undergoing PCI and treated with prasugrel, the use of BIV rather than HEP ± GPI is associated with significantly lower transfusion rate and LOS. These results suggest that the previously documented safety and cost-effectiveness benefits of BIV remain applicable when prasugrel is used.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalClinical Cardiology
Volume37
Issue number1
DOIs
StatePublished - Jan 2014

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Percutaneous Coronary Intervention
Heparin
Platelet Glycoprotein GPIIb-IIIa Complex
Length of Stay
Propensity Score
Hemorrhage
Cost-Benefit Analysis
Prasugrel Hydrochloride
bivalirudin
Cost Savings
Hospital Costs
Odds Ratio
Databases
Confidence Intervals
Safety
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel : A propensity-matched study. / Hamon, Martial; Bonello, Laurent; Marso, Steven; Rao, Sunil V.; Valgimigli, Marco; Verheugt, Freek; Gershlick, Anthony; Wang, Yamei; Prats, Jayne; Steg, Gabriel P.; Deliargyris, Efthymios.

In: Clinical Cardiology, Vol. 37, No. 1, 01.2014, p. 14-20.

Research output: Contribution to journalArticle

Hamon, M, Bonello, L, Marso, S, Rao, SV, Valgimigli, M, Verheugt, F, Gershlick, A, Wang, Y, Prats, J, Steg, GP & Deliargyris, E 2014, 'Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel: A propensity-matched study', Clinical Cardiology, vol. 37, no. 1, pp. 14-20. https://doi.org/10.1002/clc.22208
Hamon, Martial ; Bonello, Laurent ; Marso, Steven ; Rao, Sunil V. ; Valgimigli, Marco ; Verheugt, Freek ; Gershlick, Anthony ; Wang, Yamei ; Prats, Jayne ; Steg, Gabriel P. ; Deliargyris, Efthymios. / Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel : A propensity-matched study. In: Clinical Cardiology. 2014 ; Vol. 37, No. 1. pp. 14-20.
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abstract = "Background Several percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)-based regimens ± glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third-generation oral thienopyridine, has not been previously evaluated. Methods Using the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n = 3377) or HEP ± GPI (n = 3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital-level characteristics, propensity score-matching (PSM) analyses were performed. Results Mortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP ± GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95{\%} confidence interval: 0.34-0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP ± GPI (0.9 ± 2.0 vs 1.2 ± 2.3 days, P < 0.0001). Conclusions In patients undergoing PCI and treated with prasugrel, the use of BIV rather than HEP ± GPI is associated with significantly lower transfusion rate and LOS. These results suggest that the previously documented safety and cost-effectiveness benefits of BIV remain applicable when prasugrel is used.",
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T1 - Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel

T2 - A propensity-matched study

AU - Hamon, Martial

AU - Bonello, Laurent

AU - Marso, Steven

AU - Rao, Sunil V.

AU - Valgimigli, Marco

AU - Verheugt, Freek

AU - Gershlick, Anthony

AU - Wang, Yamei

AU - Prats, Jayne

AU - Steg, Gabriel P.

AU - Deliargyris, Efthymios

PY - 2014/1

Y1 - 2014/1

N2 - Background Several percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)-based regimens ± glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third-generation oral thienopyridine, has not been previously evaluated. Methods Using the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n = 3377) or HEP ± GPI (n = 3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital-level characteristics, propensity score-matching (PSM) analyses were performed. Results Mortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP ± GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95% confidence interval: 0.34-0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP ± GPI (0.9 ± 2.0 vs 1.2 ± 2.3 days, P < 0.0001). Conclusions In patients undergoing PCI and treated with prasugrel, the use of BIV rather than HEP ± GPI is associated with significantly lower transfusion rate and LOS. These results suggest that the previously documented safety and cost-effectiveness benefits of BIV remain applicable when prasugrel is used.

AB - Background Several percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)-based regimens ± glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third-generation oral thienopyridine, has not been previously evaluated. Methods Using the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n = 3377) or HEP ± GPI (n = 3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital-level characteristics, propensity score-matching (PSM) analyses were performed. Results Mortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP ± GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95% confidence interval: 0.34-0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP ± GPI (0.9 ± 2.0 vs 1.2 ± 2.3 days, P < 0.0001). Conclusions In patients undergoing PCI and treated with prasugrel, the use of BIV rather than HEP ± GPI is associated with significantly lower transfusion rate and LOS. These results suggest that the previously documented safety and cost-effectiveness benefits of BIV remain applicable when prasugrel is used.

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