Kidney Disease May Worsen Outcomes in Heart Condition
Bivalirudin reduces major bleeding compared with heparin plus a glycoprotein IIb/IIIa inhibitor
TUESDAY, Aug. 18 (HealthDay News) -- Patients with acute coronary syndromes undergoing an early, invasive strategy who also have chronic kidney disease (CKD) have worse clinical outcomes, according to a study in the August issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.
Roxana Mehran, M.D., from Columbia University Medical Center in New York City, and colleagues examined outcomes in 2,469 patients with CKD and acute coronary syndromes who were undergoing an early, invasive strategy and had been randomly assigned to a regimen of heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin alone as part of a clinical trial. Patients were part of a larger trial containing 12,939 patients with acute coronary syndromes.
The researchers found that 30-day and one-year outcomes were worse in patients with CKD compared with patients with normal renal function. Compared with heparin plus a GPI, CKD patients receiving bivalirudin alone had similar 30-day and one-year composite ischemia rates, similar one-year mortality rates, and similar net clinical adverse outcomes. However, there was significantly less major bleeding in patients taking bivalirudin alone (6.2 versus 9.8 percent).
"In patients with acute coronary syndromes, CKD is associated with higher 30-day and one-year adverse event rates," Mehran and colleagues conclude. "Compared with heparin plus a GPI, the use of bivalirudin monotherapy in patients with CKD results in non-statistically different ischemic outcomes, but significantly less 30-day major bleeding."
The trial was sponsored by The Medicines Company; several authors reported financial or consulting relationships with drug companies.