Bleeding After Percutaneous Coronary Intervention With Bivalirudin or Unfractionated Heparin and One-Year Mortality - 05/08/11
, Stefanie Schulz, MD a, Dritan Keta, MD a, Julinda Mehilli, MD a, Anette Birkmeier, MD a, Steffen Massberg, MD a, Karl-Ludwig Laugwitz, MD a, Franz-Josef Neumann, MD c, Melchior Seyfarth, MD a, Peter B. Berger, MD d, Albert Schömig, MD a, b, Adnan Kastrati, MD a
Corresponding author: Tel: 49-89-1218-4016; fax: 49-89-1218-4053Résumé |
Compared to unfractionated heparin (UFH), bivalirudin decreases bleeding during percutaneous coronary interventions (PCIs). We sought to investigate the association between periprocedural bleeding and 1-year mortality as a function of antithrombotic therapy with bivalirudin or UFH. This analysis of the association between bleeding with bivalirudin or UFH and 1-year mortality included the 4,570 patients with negative biomarkers enrolled in the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 3) trial. Major or minor bleeding occurred in 555 patients (12.1%): 225 patients treated with bivalirudin (9.8%) and 330 patients treated with UFH (14.5%, p <0.001). There were 82 deaths (1.8%) within the first year after PCI: 29 deaths occurred in patients who had bled, and 53 deaths occurred in patients who had not bled (Kaplan-Meier estimates of 1-year mortality 5.2% and 1.3%, odds ratio 4.12, 95% confidence interval 2.59 to 6.54, p <0.001). One year after PCI, there were 15 deaths in patients who bled with bivalirudin versus 14 deaths in patients who bled with UFH (Kaplan-Meier estimates of 1-year mortality 6.7% vs 4.2%, odds ratio 1.61, 95% confidence interval 0.76 to 3.40, p = 0.20). Major bleeding occurred in 70 patients (3.0%) treated with bivalirudin and 104 patients treated with UFH (4.5%, p = 0.008). One-year mortality was 11.4% (n = 8) in patients with major bleeding with bivalirudin versus 4.8% (n = 5) in patients with major bleeding with UFH (p = 0.10). In conclusion, these data suggest that in patients with negative biomarkers undergoing PCI, bivalirudin decreases bleeding after PCI compared to UFH, without affecting 1-year mortality in those who had bled.
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| This work was supported in part by Nycomed Pharma, Unterschleißheim, Germany, and by a grant from Deutsches Herzzentrum, Munich, Germany (KKF 1.1-05, 984323). |
Vol 105 - N° 2
P. 163-167 - janvier 2010 Retour au numéro
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