Bivalirudin remains superior

By Liam O’Neill at TCT 2014. 

Delegates at the 26th annual Transcatheter Cardiovascular Therapeutics (TCT) heard first hand about the Chinese BRIGHT trial, the first to compare bivalirudin,unfractionated heparin (UFH) alone, and heparin plus a GP IIb/IIIa inhibitor (tirofiban).

The new analyses and extended follow-up from the BRIGHT study demonstrated that bivalirudin remained superior to both heparin monotherapy and heparin plus tirofiban for patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

The recent controversy surrounded the optimal anticoagulant strategy for patients with acute myocardial infarction. Prior multicenter trials have demonstrated superiority of bivalirudin to heparin plus GPIIb/IIIa inhibition, but a recent trial demonstrated the superiority of heparin monotherapy over bivalirudin alone, with concern for an increased rate of stent thrombosis observed in bivalirudin-treated patients.

Key to eliminating the increased risk of stent thrombosis seen in previous trials of bivalirudin was a prolonged infusion of the drug lasting an average of nearly 4 hours after the procedure, Yaling Han, MD, of Shenyang Northern Hospital, China, reported.

Conducted at 82 Chinese sites, The BRIGHT trial included patients with acute MI eligible for emergent PCI who were randomized to bivalirudin monotherapy (n=735), heparin monotherapy (n=729) or heparin plus tirofiban (n=730). Bivalirudin was given in the cath lab before angiogram and continued for at least 30 minutes after the procedure (average duration 234 ± 117 minutes post-PCI). Bailout GPI use was allowed in the bivalirudin and heparin monotherapy arms, but was used infrequently (4.4% and 5.6%, respectively).