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Results from the recent study, called the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, showed that compared with the control group of heparin plus GP IIb/IIIa inhibitors in which the 1-year estimated rate of composite ischemia was 15.4 percent, composite ischemia occurred in 16.0 percent of patients assigned to bivalirudin plus GP IIb/IIIa inhibitors and in 16.2 percent of patients assigned to bivalirudin alone. Death at 1 year occurred in an estimated 3.9 percent of patients assigned to heparin plus GP IIb/IIIa inhibitors, 3.9 percent assigned to bivalirudin plus GP IIb/IIIa inhibitors, and 3.8 percent assigned to bivalirudin monotherapy. Between 30 days and 1 year, a trend was present for fewer deaths in the patients assigned to bivalirudin monotherapy compared to heparin plus IIb/IIIa inhibitors or bivalirudin plus IIb/IIIa inhibitors (96 vs. 114 vs. 105 deaths respectively).

At 1 year, there were no statistically significant differences in the rates of composite ischemia or mortality among patients with moderate- and high-risk ACS undergoing invasive treatment with the three anticoagulant regimens, Dr. Stone said. Thus, bivalirudin alone, which decreases bleeding and transfusions, as well as hospital costs, as well as simplifies and streamlines care compared to heparin plus IIb/IIIa inhibitors, should be favored in most patients with ACS undergoing early invasive treatment.

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