Reduced-dose of bivalirudin (without the post-procedure infusion) in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention.

Introduction: In clinical practice, the dose of bivalirudin may not be fully applicable to the Chinese population. Therefore, this study aimed to explore the efficacy and safety of a reduced dose (80% of the recommended dose) of bivalirudin without post-procedure infusion for 3-4 h in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI).

Methods: This was a single-center, retrospective study. Patients who met the inclusion criteria and no exclusion criteria were divided into reduced-dose and recommended-dose groups for analysis. Confounders were corrected using propensity score matching. The incidence of net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding events were observed 30 days postoperatively.

Results: In total, 1,590 patients (795 per group) were obtained after propensity score matching. The results after propensity score matching were as follows: The activated clotting time (ACT) after 5 min in the reduced-dose group was 349.37 ± 47.59 s, which was statistically lower than that in the recommended-dose group, 353.12 ± 44.98 s (P = 0.024). There was no significant difference in the proportion of ACT values of ≥ 250 s after 5 min between the two groups (P > 0.05). There were no significant differences in NACE, MACE, and BARC type 2-5 bleeding events between the two groups (5.0% vs. 4.5%, P = 0.638; 0.0% vs. 0.1%, P = 1.000; 0.3% vs. 0.5%, P = 0.687). There were no statistically significant differences in cumulative NACE and cumulative bleeding events between the two groups at 30 days (P = 0.635 and P = 0.716, respectively).

Conclusion: In patients with UA and NSTEMI undergoing elective PCI, 80% of the recommended dose of bivalirudin without post-procedure infusion can be used for anticoagulation without increasing the risk of thrombosis and bleeding.