Heparin Could Improve Heart Attack Procedure Outcomes

A new study suggests the use of heparin instead of the more commonly used and more expensive bivalirudin could lead to improved outcomes in preventing blood clot formation during emergency heart attack treatment.

The results of the HEAT-PPCI trial, conducted at the Liverpool Heart and Chest Hospital in Liverpool, England, indicate that systematic use of heparin rather than bivalirudin after primary percutaneous coronary intervention (PPCI)—the most widely used treatment for heart attack—could also save health services significant sums of money as well, according to researchers.
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According to the authors, many previous trials had compared the 2 drugs, but evidence remained unclear as to which drug led to better outcomes. Patients undergoing PPCI typically receive a combination of anti-thrombotic drugs to prevent further blood clots from forming during and after an emergency heart attack procedure, they noted.

For the trial, the authors recruited 1,829 patients who underwent emergency angiography. More than four-fifths of these patients then went on to receive PPCI. Approximately half received heparin while half were administered bivalirudin. The investigators recorded the number of patients from both groups who experienced a major adverse cardiac event, such as death or a subsequent heart attack, within 28 days of surgery.

The results demonstrate that overall rates of major adverse cardiac events were much lower among those receiving heparin, although the rates of adverse events were low, as was expected in both groups, according to the authors. Within 28 days after surgery, 46 patients in the bivalirudin group died, compared to 39 patients in the heparin group. In addition, 24 patients in the bivalirudin group experienced a second heart attack in the same period, compared to 7 patients from the heparin group. While bleeding complications are a known risk associated with anti-thrombotic drugs, the results found no significant difference between the groups in terms of the rate of complications.

While the drug is only given at the time of emergency angioplasty, and not administered by the primary care physician, “our study supports the cheaper—and easier to use—heparin over bivalirudin, if primary care gets involved in this aspect of emergency provision,” says Rod Stables, MA, DM, BM BCH, FRCP, a consultant interventional cardiologist at Liverpool Heart and Chest Hospital, and lead author of the study.

—Mark McGraw

Reference

Shahzad A, Kemp I, et al. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. The Lancet. 2014.