Patients with a history of stable angina or another acute coronary syndrome who have undergone percutaneous coronary intervention (PCI) may have a reduced risk of all-cause in-hospital mortality but an increased risk of bleeding when given heparin combined with glycoprotein 2b/3a inhibitors (GPI), potent antiplatelet agents, after the procedure, according to a study published Oct. 19 in JACC: Cardiovascular Interventions.  

Using data from ACC’s CathPCI Registry, researchers assessed records from 970,865 patients between July 2009 and September 2011. Almost one-third of cases were treated with GPI. After adjusting for many factors, relative risk reductions in mortality ranged from 10 to 28 percent. The risk reduction in mortality was enhanced in patients with myocardial infarction. However, after risk adjustments, GPI use was found to be associated with an increased risk of major bleeding.

“These findings suggest that in the modern era of PCI, there may still be a role for the judicious use of GPI in high-risk patients, particularly if heparin is used for anticoagulation, as it was in over one-half of patients included in this study,” says David M. Safley, MD, FACC, the study’s lead author. Safley notes the findings “also serve to highlight the relatively low usage of bivalirudin.”

In an accompanying editorial, A. Michael Lincoff, MD, FACC, notes the limitations due to the observational nature of the analysis. “Without randomization, any observed associations between the treatment variable (GPI) and outcome cannot be proven to be causative,” Lincoff writes.

While acknowledging the robustness of the statistical methods used, Lincoff adds, “There is no advantage of GPI over bivalirudin, and the latter strategy reduces bleeding.” 

Keywords: Acute Coronary Syndrome, Angina Pectoris, Angina, Stable, Anticoagulants, Heparin, Hirudins, Myocardial Infarction, Peptide Fragments, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Registries, Risk, Risk Adjustment, Risk Reduction Behavior, National Cardiovascular Data Registries, CathPCI Registry

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