Reduced-dose of Bivalirudin in patients undergoing percutaneous coronary intervention in Bangladeshi population A single center study

Abstract

Introduction: Bivalirudin as an anticoagulant that reduces bleeding as compared to heparin after percutaneous coronary intervention (PCI) At present, the recommended dose of Bivalirudin is mainly based on European and American guidelines. It is widely accepted that the East Asian population has a lower risk of ischemia and a higher risk of bleeding than non-East Asian populations. In clinical practice, the dose of Bivalirudin may not be fully applicable to the Bangladeshi population. Therefore, this study aimed to explore the efficacy and safety of a reduced dose (Two third of the recommended bolus dose followed by half of recommended maintenance dose) of Bivalirudin in patients undergoing PCI.

Methods: This was a single-center, observational study which was conducted in the department of Cardiology National Heart Foundation hospital & Research Institute from May 2016 to March 2023. Patients who met the inclusion and exclusion criteria were included. All the patients were given Bivalirudin (reduced dose) & observed for in hospital outcomes (major bleeding or hematoma needed blood transfusion, minor bleeding, stent thrombosis, cardiogenic shock & all-cause mortality).

Results: In total 1143 patients were included. Mean age of study population was 58.26±11.38 & majority of patients were male (54.9%). Majority of patients were chronic coronary syndrome(CCS) (58.2%) while rest of the patients were acute coronary syndrome(ACS). 52.9% patients underwent Multivessel PCI, among them Rotabalation were done in 4.8% cases & left main (LM) PCI were done in 19.2 % patients. The Mean activated clotting time (ACT) after 5 min was 298.3 ± 68.511sec. Regarding the in-hospital outcomes, 1.7 % patients developed major bleeding or hematoma needed blood transfusion, 1.2 % patient developed minor bleeding, 1.7% patient had cardiogenic shock, all-cause mortality were 2.0% & only 0.8% patient had in hospital stent thrombosis.

Conclusion: In Bangladeshi population, patients undergoing PCI, reduced dose Bivalirudin can be used for anticoagulation without increasing the risk of thrombosis and bleeding.