Drug Reduces Bleeding in Elderly After Heart Ischemia

Efficacy of bivalirudin similar across age groups

TUESDAY, March 17 (HealthDay News) -- The anti-thrombotic bivalirudin (Angiomax) is effective in improving ischemic outcomes and lowering bleeding complications in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), particularly in elderly patients aged 75 years and older who are at higher risk of bleeding, according to a study published in the March 24 issue of the Journal of the American College of Cardiology.

Renato D. Lopes, M.D., Ph.D., from Duke University Medical Center in Durham, N.C., and colleagues analyzed outcomes based on age in 13,819 patients with moderate- and high-risk NSTE-ACS who had been randomly assigned to one of three anti-thrombotic regimens as part of a clinical trial: a heparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor or bivalirudin alone.

The researchers found that there were more ischemic and bleeding complications with increasing age after NSTE-ACS. The rate of ischemic events was similar in all three groups, but bleeding rates were lower for patients receiving bivalirudin alone compared with the other groups and with those receiving percutaneous coronary intervention. In patients aged 75 and older who were at higher risk of bleeding, bivalirudin treatment alone led to similar ischemic outcomes but significantly lower bleeding rates. This resulted in the need for only 23 patients overall or 16 percutaneous coronary intervention-treated patients to be treated with bivalirudin alone to prevent one major bleeding event.

"This analysis confirms no significant differences in efficacy but superior safety among patients randomized to a strategy of bivalirudin alone compared with a strategy of heparin plus a glycoprotein IIb/IIIa inhibitor across patient age," Lopes and colleagues conclude. "Furthermore, it emphasizes that the absolute reduction in bleeding events is most pronounced in the oldest patient subgroup (age 75 years and greater), which then translates into the lowest number needed to treat in this age range."

Several authors have financial or consulting relationships with the pharmaceutical industry, including The Medicines Company, which makes bivalirudin (Angiomax).

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