Anticoagulation following primary PCI did not prevent adverse outcomes in patients with STEMI, according to results from the RIGHT trial presented at ESC Congress 2023.

A total of 2,989 patients with STEMI undergoing primary PCI at 53 centers in China were randomized to receive placebo (n=1495) or low-dose post-procedural anticoagulation (PPA) consisting of enoxaparin, unfractionated heparin, or bivalirudin (n=1,494) for at least 48 hours. The mean age of participants was 60.9 years, 20.7% were women, 24.5% had diabetes mellitus, and 54.5% had hypertension.

The primary efficacy objective, to demonstrate superiority of PPA to reduce the primary efficacy endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke, definite stent thrombosis, or urgent revascularization of any vessel within 30 days, occurred in 37 patients (2.5%) in both the PPA and placebo groups. However, researchers noted a significant interaction was observed for the type of anticoagulant and the primary endpoint (p=0.015): enoxaparin vs. placebo, HR 0.46; unfractionated heparin vs. placebo, HR 3.71; and bivalirudin vs. placebo, HR 1.24. There was no excess major bleeding globally or in any of the three anticoagulant groups.

"Overall, the results of the RIGHT trial suggest that anticoagulation after primary PCI for STEMI is safe but does not appear to reduce ischemic events in a low-to-intermediate risk population," said Shaoping Nie, MD, of Capital Medical University, Beijing, China. "Whether enoxaparin anticoagulation may be beneficial after primary PCI requires further study."

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Anticoagulation Management and ACS

Keywords: ESC Congress, ESC23, ACC International, Acute Coronary Syndrome, Anticoagulants

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