Bivalirudin: Treatment effect versus side effect

摘要

Alexopoulos et al. [1] presented interesting data showing that in “real-life” scenario, there are no differences in one-month outcome between bivalirudin- and no bivalirudin-treated patients. When talking about bivalirudin efficacy, we have to consider two distinct features: treatment effect (antithrombotic action) and side effect (bleeding events). In HORIZONS-AMI trial, there was a reduction in cardiac mortality in the bivalirudin group that can only partly be attributed to prevention of bleeding [2]. Notwithstanding, in EUROMAX trial, there was a substantial decline in bleeding events which did not transfer into survival benefit [3]. Repeatedly, however, there was a higher incidence of stent thrombosis and a trend toward a higher incidence of myocardial infarction [3, 4], despite investigators' attempts to prevent it by prolonging bivalirudin infusion to 4 h following PCI. So actually, in terms of treatment effect, the study proved the drug not to be so efficacious.