Bivalirudin and Unfractionated Heparin Compared for Patients With End-Stage Renal Disease Undergoing PCI
February 12, 2018—Jeffrey B. Washam, PharmD, et al published a study online in Circulation: Cardiovascular Interventions analyzing anticoagulant use in patients with end-stage renal disease (ESRD) undergoing percutaneous coronary intervention (PCI).
As background, the investigators noted that patients with ESRD undergoing PCI have been largely excluded from trials evaluating antithrombotic therapies, which leaves little data to guide agent choice in this population.
Investigators used the National Cardiovascular Data Registry CathPCI Registry to identify patients with ESRD undergoing PCI who received monotherapy with either bivalirudin or unfractionated heparin (UFH) (n = 71,675). Bivalirudin was used in 51.3% of patients versus 48.7% for UFH. However, during the study observation period, bivalirudin use decreased and UFH became the most frequently used antithrombotic therapy.
As summarized in Circulation: Cardiovascular Interventions, patients receiving UFH were more likely to have an acute coronary syndrome presentation (37.8% vs 27.4%) or have cardiogenic shock (3.74% vs 1.98%). Patients receiving bivalirudin had lower observed rates for in-hospital bleeding (7% vs 9.5%; adjusted odds ratio [OR], 0.82; 95% confidence interval [CI], 0.76–0.87) and mortality (2.6% vs 4.2%; adjusted OR, 0.87; 95% CI, 0.78–0.97) compared with patients receiving UFH.
Bivalirudin and UFH were used with similar frequency among patients with ESRD undergoing PCI, but use patterns changed over time. Patients had lower adjusted risk of in-hospital outcomes with bivalirudin; however, the investigators in Circulation: Cardiovascular Interventions recommended a randomized trial be undertaken given that this was an observational analysis.