1. BRIGHT
Trial design: Patients undergoing PCI for ACS were randomized in a 1:1:1 fashion to receive either bivalirudin alone, unfractionated heparin (UFH) alone, or UFH + tirofiban. Patients were followed for 1 year.
(p < 0.001)
Results
Composite 30-day NACE endpoint (MACCE + bleeding) for bivalirudin vs. UFH vs. UFH + tirofiban: 8.8% vs. 13.2% vs. 17.0%; p < 0.001
BARC 3-5 (major) bleeding: 0.5% vs. 1.5% vs. 2.1%, p = 0.04; stent thrombosis: 0.6% vs. 0.9% vs. 0.7%, p = 0.77
NACE at 1 year: 12.8% vs. 16.5% vs. 20.5%, p < 0.001 20
17.0
13.2 % 10
8.8
Conclusions
Bivalirudin as choice of anticoagulant is superior to UFH and UFH + tirofiban in patients with ACS undergoing PCI; however, there was no increase in the risk of stent thrombosis with bivalirudin monotherapy
Controversial topic; UFH dosing in this trial (100 U/kg) higher than conventional dose (70 U/kg)
NACE at 30 days
Bivalirudin
(n = 735)
UFH
(n = 729)
UFH + GPI
(n = 730)
Presented by Dr. Ya-Ling Han at TCT 2014