Extending bivalirudin after PCI not helpful

By Mark Watson

Results from the Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angio (MATRIX) reveal that prolonged use of the drug post-PCI does not prevent bleeding or stent thromboses any better than not extending its use for at least an additional 4 hours.

The study is one of a series of three randomised trials involving patients with acute coronary syndromes. Between 2011 and 2014, 3610 patients were randomised to receive bivalirudin either during PCI only (n = 1,188) or both during and after the procedure (n = 1,799).

The net adverse coronary events with continuation of bivalirudin post-interventions was 11% which was not significantly different from the 11.9% rate observed if no bivalirudin was administered after the procedure (RR 0.91, P=0.34).

“The study leaves both options open. There were no safety signals with respect to prolonging bivalirudin - which had been a professional concern,” said study presenter Marco Valgimigli from the Swiss Cardiovascular Centre, Bern. The results, wrote the authors, reinforce the concept that reducing the rate of major bleeding events among patients with acute coronary syndromes treated with PCI does not necessarily affect the risk of major ischaemic adverse cardiovascular events. “The difference between the findings of this study and other studies may reflect the way in which nonfatal peri procedural ischaemic events and bleeding events were defined,” they suggest.

Nevertheless, according to an accompanying editorial in the NEJM, “the MATRIX trial provides the best evidence to date on the question of whether prolonging the infusion of bivalirudin after the end of the PCI procedure is beneficial”.