Comparison in curative effects between unfractionated heparin and bivalirudin in patients with acute myocardial infarction during PCI

Zhang Huifeng; Dong Pingshuan; Wang Ke; Yan Peng; Zhao Xikun; Zhao Jingdong

doi:10.3969/j.issn.1674-4055.2018.04.18

Abstract：Objective To compare the curative effect and safety between unfractionated heparin (UFH) and bivalirudin in patients with acute myocardial infarction (AMI) during percutaneous coronary intervention (PCI). Methods AMI patients (n=153, male 81, female 72 and aged from 65 to 87) were chosen from the First Affiliated Hospital of Henan University of Science and Technology from June 2016 to Mar. 2017. All patients were divided into UFH group (n=76) and bivalirudin group (n=77) according to random digital table. The bivalirudin group was given bivalirudin before and during PCI, and UFH group was given UFH injection before PCI. Platelet count and activated clotting time (ACT) were detected before medication and re-detected after medication for 1 h, 4 h and 24 h. The incidence of major adverse cardiovascular events (MACE) and bleeding events were observed in 2 groups after treatment for 1 y. Results ACT was (151.3±32.9) s in bivalirudin group, which was significantly lower than that in UFH group [(280.7±35.9) s] after medication for 1 h, and ACT was still lower in bivalirudin group than that in UFH group [(143.5±28.9) s vs. (214.9±39.9) s] after medication for 4 h (all P<0.05). The comparison in platelet count showed the difference had no statistical significance between 2 groups at all time points (all P>0.05). There were 10 cases (13.0%) of MACE in bivalirudin group and 13 (17.1%) in UFH group (P>0.05). There were no severe bleeding events observed in 2 groups. The incidence of non-significant bleeding was 9.1% in bivalirudin group and 32.9% in UFH group (P<0.001). The total bleeding rate was 10.4% in bivalirudin group and 36.8% in UFH group (P<0.001). Conclusion Bivalirudin can obtain well anti-coagulation effect, reduce bleeding rate and not increase MACE incidence compared with UFH in AMI patients during PCI.