A recent study in Thrombosis Research showed that there was no difference between unfractionated heparin (UFH) or bivalirudin in inhibiting coagulation and platelet activation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) post-ticagrelor treatment.
This randomized, single center sub study pre-treated STEMI participants undergoing PPCI with ticagrelor prior to administering either UFH or bivalirudin to observe their effects. The UFH treated group (n=52) were administered 70 to 100U per kg and the bivalirudin group (n=51) were administered an initial intravenous bolus (0.75 mg per kg of body weight) followed by an infusion of 1.75 mg per kg per hour.
Blood collection at 3 time points (post-randomization but pre-treatment, 60 to 80 min post-randomization, and 12 hours post-randomization) allowed analysis of platelet and coagulation activation markers.
The results showed that the UFH group had a median time (interquartile range) from symptom onset to ticagrelor administration of 130 (234) minutes, compared with the bivalirudin group’s 115 (103) minutes. The bivalirudin group was administrated prior to the catherization lab arrival in 88% of participants compared with the UFH group (87%, P =.80).
There was no significant difference in adenosine diphosphate-induced platelet aggregation between the groups. There was no significant difference in soluble P-selectin at any time point between the groups. There was a significant increase (60 to 80 minutes after randomization) in thrombin-antithrombin complexes in the bivalirudin group in comparison with baseline; however, this was not observed in the UFH group.
There was no significant difference between the groups in interleukin 2 12 hours post-randomization.
The authors noted the limited sample size and deficiency of sample size calculation as limitations of the study.
These findings suggest that there is no difference between heparin and bivalirudin in terms of platelet aggregation or coagulation markers after pretreatment with ticagrelor in patients undergoing PPCI.
Disclosures: This study was supported by AstraZeneca. Please refer to original reference for a full list of authors’ disclosures.
Venetsanos D, Lindahl TL, Lawesson SS, et al. Pretreatment with ticagrelor may offset additional inhibition of platelet and coagulation activation with bivalirudin compared to heparin during primary percutaneous coronary intervention. Thromb Res. 2018; 171:38-44.