קרדיולוגיהבעריכת ד"ר מנחם נהיר

Bivalirudin reduces reinfarction risk after acute MI compared with heparin

WESTPORT, CT (Reuters Health) – Administration of the new thrombin-specific anticoagulant bivalirudin (Angiomax, formerly known as Hirulog) significantly reduces the rate of early reinfarction after acute myocardial infarction by 30% compared with heparin use, according to a report in The Lancet for December 1.

Dr. Harvey White from Green Lane Hospital in Auckland, New Zealand, and colleagues from the Hirulog and Early Reperfusion or Occlusion (HERO)-2 trial randomly assigned 17,073 patients to an intravenous bolus plus 48-hour infusion of either bivalirudin or unfractionated heparin after acute ST-segment MI. Before receiving the anticoagulant, patients were given a standard dose of streptokinase.

At 30 days after therapy, the death rates in the two treatment groups were similar: 10.8% for patients receiving bivalirudin and 10.9% for those receiving heparin (p = 0.85). However, the rate of reinfarction within 96 hours of treatment was significantly lower in the bivalirudin group (p = 0.001), the HERO-2 investigators found.

Among patients receiving bivalirudin, 0.7% had episodes of severe bleeding compared with 0.5% of the patients receiving heparin (a nonsignificant difference at p = 0.07). Intracerebral bleeding occurred in 0.6% of the patients receiving bivalirudin and 0.4% of those receiving heparin (a nonsignificant difference at p = 0.09).

Moderate bleeding was more common among patients in the bivalirudin group than among patients in the heparin group (p = 0.05), as was mild bleeding (p < 0.0001), Dr. White's group notes.

The rate of a combination endpoint of death, nonfatal reinfarction, or nonfatal disabling stroke was significantly lower in the bivalirudin group (12.7%) compared with the heparin group (13.8%, p = 0.049), the investigators add.

They conclude that "bivalirudin should be considered as a new anticoagulant treatment option in patients with acute myocardial infarction treated with streptokinase."

Lancet 2001;358:1855-1863.

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