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Bivalirudin vs Heparin in PPCI — EECC MCQ

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HardCoronary Artery DiseaseBivalirudin vs Heparin in PPCIEECC

A 60-year-old man undergoes primary PCI for STEMI. The operator uses bivalirudin instead of unfractionated heparin with a glycoprotein IIb/IIIa inhibitor. What is the evidence for bivalirudin in primary PCI?

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Correct answer: A — The MATRIX and VALIDATE-SWEDEHEART trials showed bivalirudin reduces major bleeding compared with heparin but has a signal for increased acute stent thrombosis; overall mortality is similar

Bivalirudin (a direct thrombin inhibitor) versus UFH (with or without GP IIb/IIIa inhibitors) during primary PCI has been extensively studied. The HORIZONS-AMI, EUROMAX, HEAT-PPCI, MATRIX, and VALIDATE-SWEDEHEART trials show: bivalirudin consistently reduces major/net bleeding complications, but has a signal for increased acute stent thrombosis in some studies (particularly without post-procedural infusion). All-cause mortality is similar between strategies. The 2023 ESC ACS Guidelines include bivalirudin as an alternative to UFH during primary PCI (Class IIa), particularly in patients at high bleeding risk. A post-PCI bivalirudin infusion (1.75 mg/kg/h for 2-4 hours) may mitigate the stent thrombosis risk.

Reference: ESC (2023): ACS Guidelines; MATRIX/VALIDATE Trials