In a recently released update of guidelines issued jointly by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society of Cardiovascular Angiography and Interventions (SCAI), the short-acting anticoagulant bivalirudin received an upgraded recommendation as a measure that may improve the safety of angioplasty with stenting in people who are suffering a major heart attack. Bivalirudin, which belongs to a class of drugs known as direct thrombin inhibitors, is marketed as Angiomax.
The impetus for the new recommendation stemmed mainly from results of the HORIZONS AMI trial, which was led by CRF faculty member Gregg W. Stone, MD.
In the 3,602-patient multicenter trial, which was published in the New England Journal of Medicine last year, people who suffered a significant heart attack, called an ST-segment elevation myocardial infarction, were randomly assigned to receive either the standard blood thinner heparin plus an antiplatelet agent or bivalirudin alone before undergoing angioplasty with stenting. At 30 days, the two groups of patients had experienced comparable rates of major cardiovascular complications. But because those who received bivalirudin had significantly less major bleeding—which in turn translated into a lower risk of heartrelated death—the bivalirudin group benefited from a lower complication rate.
The small but significant increase in early sudden stent clotting, known as stent thrombosis, seen with bivalirudin may be counteracted by prior use of heparin, the guideline writers suggested.
The HORIZONS AMI research team also included several other CRF faculty members: George D. Dangas, MD, PhD, Ajay J. Kirtane, MD, SM, Roxana Mehran, MD, and Helen Parise, ScD.
