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The impact of bivalirudin on percutaneous coronary intervention-related bleeding

医学 比伐卢定 经皮冠状动脉介入治疗 不稳定型心绞痛 传统PCI 心脏病学 内科学 血管闭合器 肝素 倾向得分匹配 经皮 心肌梗塞 外科
作者
Jason B. Lindsey,David J. Cohen,Joshua M. Stolker,Sameer K Meht,Elizabeth M. Mahoney,Katherine Robertus,John A. House,Kevin F. Kennedy,Lisa Riggs,Sunil V. Rao,Steven P. Marso
出处
期刊:Eurointervention [European Association of Percutaneous Cardiovascular Interventions]
卷期号:6 (2): 206-213 被引量:18
标识
DOI:10.4244/eijv6i2a33
摘要

We studied the clinical and economic impact of bivalirudin in clinical practice.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).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.
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