The impact of bivalirudin on percutaneous coronary intervention-related bleeding

Jason B. Lindsey, David J. Cohen, Joshua M. Stolker, Sameer K. Mehta, Elizabeth Mahoney, Katherine Robertus, John A. House, Kevin Kennedy, Lisa Riggs, Sunil V. Rao, Steven P. Marso

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Aims: We studied the clinical and economic impact of bivalirudin in clinical practice. Methods and results: Consecutive patients undergoing PCI via the common femoral artery for stable, unstable, or atypical angina, silent ischaemia, or non-ST-elevation myocardial infarction indications during 2007-2008 were prospectively studied. In-hospital bleeding events were systematically assessed and classified as either major or minor. Use of bivalirudin, vascular closure devices, heparin and/or glycoprotein (GP) IIb/IIIa inhibitor was at the operator's discretion. Among 1,364 patients, 503 received bivalirudin and 861 received usual care consisting of either heparin monotherapy (n=687) or heparin+GP IIb/IIIa (n=174). Any post-PCI bleeding occurred in 356 (26.1%) patients, including 32 (2.3%) major and 324 (23.8%) minor events. Compared with usual care, bivalirudin was associated with reduced bleeding before adjustment (any: 17.3% vs. 31.2%, P<0.001; major: 1.2% vs. 3.0%, P=0.03; minor: 16.1% vs. 28.2%, P<0.01) and after propensity-matching (OR 0.46, 95% CI 0.34-0.63, P<0.001). Use of vascular closure devices was associated with an increase in any bleeding (32.2% vs. 17.7%, P<0.001), primarily due to an increase in minor bleeding (30.8% vs. 14.1%, P<0.001) while there was a significant decrease in major bleeding (1.4% vs. 3.7%, P=0.007). Bivalirudin was associated with total hospitalisation costs that were lower than usual care (mean cost savings, $463/patient; 95% CI 1,594 less to 621 more). Conclusions: In this prospective PCI cohort, bivalirudin was associated with reduced major and minor bleeding without a significant increase in hospital costs compared with other anticoagulation regimens. Closure device use was associated with decreased major but increased minor bleeding.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalEuroIntervention
Volume6
Issue number2
DOIs
StatePublished - Jun 1 2010

Keywords

  • Anticoagulation
  • Bleeding
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lindsey, J. B., Cohen, D. J., Stolker, J. M., Mehta, S. K., Mahoney, E., Robertus, K., House, J. A., Kennedy, K., Riggs, L., Rao, S. V., & Marso, S. P. (2010). The impact of bivalirudin on percutaneous coronary intervention-related bleeding. EuroIntervention, 6(2), 206-213. https://doi.org/10.4244/EIJV6I2A33