In patients with the acute coronary syndrome (ACS) managed invasively with revascularization and coronary angiography, the ideal method for preventing ischemia and coronary thrombosis is not certain. This study aims to investigate the efficacy of bivalirudin and unfractionated heparin, two antithrombotic regimens, for preventing cardiovascular outcomes in patients with ACS.

This randomized control trial included a total of 7,213Q patients with ACS with or without ST-segment elevation (4,010 with ST-segment elevation and 3,203 without ST-segment elevation). The patients were randomly assigned to bivalirudin with glycoprotein IIb/IIIa inhibitors (bivalirudin group) or heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group). The primary outcomes of the study were the occurrence of major adverse cardiovascular events, including death, myocardial infarction (MI), or stroke.

In patients with ST-segment elevation, major adverse cardiovascular events occurred in 5.9% of the patients with the bivalirudin group and 6.5% of the patients in the heparin group. The rate of incidence of adverse clinical events was 7.0% in the bivalirudin group and 8.2% in the heparin group. In patients without ST-segment elevation, cardiovascular events occurred in 15.9% of the patients with the bivalirudin group and 16.4% of the patients in the heparin group.

The research concluded that bivalirudin monotherapy did not reduce the risk of cardiovascular events in patients with ACS with or without ST elevation when compared with heparin therapy.

Ref: https://www.bmj.com/content/354/bmj.i4935