Author + information
- Emily Perdoncin,
- Min Zhang,
- Arthur Riba,
- Thomas LaLonde,
- Cindy Grines,
- David Share and
- Hitinder Gurm
To evaluate the impact of worsening renal function on the comparative bleeding risk associated with use of bivalirudin versus GP IIbIIIa inhibitors (GPI) in patients undergoing percutaneous coronary intervention (PCI).
Use of bivalirudin has been associated with a reduction in the incidence of bleeding in patients undergoing PCI. Patients with chronic kidney disease (CKD), a known predictor of post-PCI bleeding, are underrepresented in clinical trials.
We evaluated the outcome of 64,052 patients who underwent PCI from 2008-2009 at 30 hospitals in Michigan who were treated with bivalirudin (28,378) or with heparin and GP IIbIIIa inhibitors (35,674). Propensity matched analysis adjusted for the non-randomized use of the two strategies.
Patients treated with bivalirudin were older, had a lower GFR and more comorbidities. Use of bivalirudin was associated with fewer transfusions (2.7% vs. 4%, p <0.0001), GI bleeds (0.5% vs. 1.2%, p <0.0001) and vascular complications (1.0% vs. 2.4%, p<0.0001), with no difference in survival. Bleeding complications were more common with worsening renal function, but use of bivalirudin was associated with less bleeding across the continuum of renal dysfunction.
The risk of bleeding after PCI rises with worsening CKD. Bivalirudin was associated with a dramatically reduced risk of bleeding across all categories of renal dysfunction.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Surprises and Controversies in Outcomes Research
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1243M-94
- 2013 American College of Cardiology Foundation