Comparison Of The Anticoagulant Effect Of Bivalirudin And Heparin In Direct PCI Under The Dual Antiplatelet Regimen Of Ticagrelor Combined With Aspirin

Objective To compare the efficacy and safety of bivalirudin and heparin in the dual antiplatelet regimen of ticagrelor combined with aspirin during direct emergency PCI in patients with acute ST-segment elevation myocardial infarction.Methods The patients were hospitalized in the emergency department of the First Affiliated Hospital of University of Science and Technology of China(USTC)on January 1,2018 for acute ST-segment elevation myocardial infarction(STEMI)on December 31,2020.Moreover,patients undergoing direct percutaneous coronary intervention(PCI)were successfully treated.All patients received load-dose aspirin and ticagrelor combined antiplatelet therapy before emergency PCI.According to the anticoagulant drugs used in emergency PCI,the patients were divided into bivalirudin group and common heparin group.Basic data,ancillary examination results,coronary angiography data and PCI results of patients in both groups were collected.All patients were followed up and recorded for bleeding events and major adverse cardiovascular events(MACE,including cardiac death,non-fatal myocardial infarction,and ischemic stroke)during the perioperative period,30 days postoperatively,and 6 months postoperatively.Chi-square test was used to analyze and compare the differences in bleeding and major adverse cardiovascular events between the two groups during each follow-up period.Subgroup analysis was performed according to patients’age,gender,anemia,diabetes and other related risk factors.Results Among the 337 patients with complete data and qualified for inclusion,180 cases were in the bivalirudin group and 157 cases were in the common heparin group.There was no significant difference in baseline data between the two groups,including gender,age,weight,history of diabetes,history of hypertension,smoking history,previous history of PCI,history of stroke,cardiac function grade,anemia or not(p>0.05).Treatment includes two groups of patients in the preoperative medication doses of aspirin(including load,load dose for Greg los),interventional diagnosis and treatment(including coronary angiography,percutaneous coronary intervention,etc.)and postoperative medication(including aspirin,for Greg lowe,etc.)use of comparison,there were no statistical differences(p>0.05).Perioperative bleeding events were 1.1%in the bivalirudin group and 4.5%in the common heparin group,with no statistical significance(p=0.057).The incidence of MACE events was 6.1%and 8.9%,the difference was not statistically significant(p=0.231).The bleeding events at 30 days were 2.2%in the bivalirudin group and 6.4%in the common heparin group,and the difference was not statistically significant(p=0.057).The incidence of MACE events was 6.7%and 10.2%,the difference was not statistically significant(p=0.169).The bleeding events at 6 months were 2.2%in the bivalirudin group and 8.3%in the common heparin group,and the difference was statistically significant(p<0.001).The incidence of MACE events was 6.7%and 12.7%,the difference being statistically significant(p=0.039).Among the selected patients,there were 99 female patients with STEMI.The subgroup analysis showed that the incidence of all bleeding events in bivalirudin group(1.7%)was lower than that in unfractionated heparin group(14.6%)(p<0.05);In mace events,bivalirudin group and unfractionated heparin group were 1.7%and 4.9%respectively,and the difference was not statistically significant(p>0.05).Among the selected patients,there were 100 elderly STEMI patients aged>75 years.The subgroup analysis showed that the incidence of all bleeding events in bivalirudin group(2.2%)was lower than that in unfractionated heparin group(13.6%)(p<0.05);In mace events,bivalirudin group and unfractionated heparin group were 4.3%and 9.1%respectively,and the difference was not statistically significant(p>0.05).Among the selected patients,there were 99 diabetic patients with STEMI.Subgroup analysis showed that 6 months follow-up showed that there was no significant difference between the two groups(5%)and 4.9%(p>0.05),and there was no significant difference in the incidence of MACE between two groups(p>0.05).Bivalirudin group and unfractionated heparin group were 2.5%and 7.3%respectively.Among the selected patients.there were 84 patients with anemia STEMI.The subgroup analysis showed that the incidence of all bleeding events in bivalirudin group(2.3%)was lower than that in unfractionated heparin group(15.0%)(p<0.05);The incidence of mace events in bivalirudin group and unfractionated heparin group were 2.3%and 9.7%respectively(p<0.05).Conclusion 1.On the basis of dual antiplatelet therapy with aspirin combined with ticagrelor,the use of bivalirudin and common heparin as anticoagulant therapy during emergency direct PCI in STEMI patients showed similar efficacy and safety during perioperative and 30-day follow-up.During 6 months of follow-up,there was a better net clinical benefit compared to the common heparin bivalirudin group;2.Based on the dual antiplatelet therapy of aspirin combined with ticagrelor,during 6 months of follow-up,ivalirudin has better curative effect than heparin in patients with anemia STEMI during direct PCI;Compared with heparin,verapamil has better safety in direct PCI in female,elderly and anemia STEMI patients.