The following is a summary of “Bivalirudin vs Heparin Anticoagulation in STEMI: Confirmation of the BRIGHT-4 Results,” published in the October 2024 issue of Cardiology by Stone et al.    

In the Bivalirudin with Prolonged Full-Dose Infusion During Primary PCI Versus Heparin Trial-4 (BRIGHT-4), bivalirudin anticoagulation reduced all-cause mortality and bleeding without increasing reinfarction or stent thrombosis compared to heparin alone in patients with ST-segment elevation myocardial infarction (STEMI).  

Researchers conducted a retrospective study determining the outcomes of bivalirudin vs. heparin anticoagulation during percutaneous coronary intervention (PCI) in patients with STEMI.  

They performed an individual-patient-data meta-analysis of large RCTs (6 trials) comparing bivalirudin vs. heparin in patients with STEMI undergoing primary PCI.  

The results showed that bivalirudin reduced 30-day all-cause mortality (2.5% vs. 2.9%; aOR: 0.78; 95% CI: 0.62-0.99), cardiac mortality (aOR: 0.69; 95% CI: 0.54-0.88), and major bleeding (aOR: 0.53; 95% CI: 0.44-0.64) but increased reinfarction (aOR: 1.30; 95% CI: 1.02-1.65) and stent thrombosis (aOR: 1.43; 95% CI: 1.05-1.93) compared with heparin. In 4 trials with 6,244 patients randomized to bivalirudin plus a high-dose post-PCI infusion vs. heparin without planned glycoprotein IIb/IIIa inhibitor (GPI) use, 30-day all-cause mortality was 1.8% vs. 2.9% (aOR: 0.74; 95% CI: 0.48-1.12), and bivalirudin reduced cardiac mortality (aOR: 0.62; 95% CI: 0.39-0.97) and major bleeding (aOR: 0.49; 95% CI: 0.35-0.70), with similar rates of reinfarction (aOR: 0.89; 95% CI: 0.58-1.38) and stent thrombosis (aOR: 0.80; 95% CI: 0.41-1.57).  

They concluded that bivalirudin with a 2- to 4-hour high-dose post-PCI infusion reduced cardiac mortality and major bleeding without increasing ischemic events compared to heparin monotherapy with provisional GPI use, confirming the BRIGHT-4 results.  

Source: jacc.org/doi/10.1016/j.jacc.2024.07.045