1 ratings / 4 average

Anticoagulant Therapy

Dangas GD, Mehran R, Nikolsky E et al.; HORIZONS-AMI Trial Investigators. J Am Coll Cardiol 2011;57:2309–16.

In this analysis of HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction [MI]) trial data, the authors examined the outcomes of switching from heparin to bivalirudin treatment in patients with ST-segment elevation MI (STEMI) who had received heparin prior to angiography. Consistent with the results of the main trial, the results of this analysis showed that bivalirudin is associated with a lower rate of bleeding events, and also lower rates of short- and long-term cardiac-related mortality. Thus, antithrombin switching appears to be a viable and safe option for STEMI patients who have previously been treated with heparin.


Previous concerns have been raised about antithrombotic agent switching, particularly between unfractionated and low-molecular-weight heparin, resulting in excessive bleeding [1]. For patients with non-ST-segment elevation myocardial infarction (NSTEMI), switching from unfractionated heparin to bivalirudin has been shown to be safe [2]; however, no data for patients with STEMI are available. The HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute MI) trial was an open-label, randomized, multicenter trial to compare a treatment strategy of unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) with bivalirudin monotherapy in patients with acute MI [3]. As treatment with unfractionated heparin is commonly initiated early (prior to angiography), the investigators stratified randomization by pre-enrollment unfractionated heparin use. If the patient was randomized to bivalirudin, bivalirudin treatment was initiated 30 min after the last heparin bolus but prior to percutaneous coronary intervention.

Return to top