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Pre-Hospital Bivalirudin Improves Outcomes Compared With Heparin in Heart Attack Patients

Death rate and major bleeding reduced (October 30)

According to a new study, administering the blood thinner bivalirudin (Angiomax, Medicines Company) to patients experiencing an ST-elevation myocardial infarction (STEMI, the most serious form of a heart attack) in a pre-hospital setting can reduce the risk of death and major bleeding complications compared with heparin with optional use of glycoprotein IIb/IIIa inhibitors (GPIs).

Findings from the EUROMAX trial were reported Oct. 30 at the 25th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium in San Francisco and were simultaneously published in the New England Journal of Medicine.

While bivalirudin has been compared with other blood thinners in hospital settings, the EUROMAX study is the first to evaluate these anticoagulant therapy options prior to hospital admission and in conjunction with newer P2Y12 inhibitors, such as prasugrel (Effient, Daiichi Sankyo/Eli Lilly) and ticagrelor (Brilinta, AstraZeneca).

The randomized, prospective, open-label ambulance trial enrolled 2,198 patients with STEMI and intended for primary percutaneous coronary intervention (PCI), presenting either via ambulance or to centers where PCI is not performed. The study’s primary endpoint was a composite incidence of death or non-coronary artery bypass graft (CABG)-related protocol major bleeding at 30 days, assessed by intention to treat.

Patients were randomly assigned to treatment with either bivalirudin (n = 1,089) or heparin (n = 1,109) at guideline-recommended doses (with or without routine or bailout GPIs).

After 30 days, patients that received bivalirudin, compared with the heparin group, experienced a significantly lower rate of death and major bleeding (5.1% vs. 8.4%, respectively). The secondary composite outcome of death, reinfarction, and major bleeding at 30 days was also reduced with bivalirudin compared with heparin (6.7% vs. 9.1%, respectively). Despite a lower rate of bleeding complications in the bivalirudin-treated patients, the risk of acute stent thrombosis was higher in the bivalirudin group compared with the heparin group (1.1% vs. 0.2%, respectively).

Source: Cardiovascular Research Foundation; October 30, 2013.

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