{"id":"e5286eee1f62","type":"article","url":"https://hartvaat.nl/2024/10/15/bright-4-bevestiging-bivalirudine-superieur-aan-heparine-bij-stemi/","title":"BRIGHT-4 bevestiging: bivalirudine superieur aan heparine bij STEMI","title_en":"Bivalirudin vs Heparin Anticoagulation in STEMI: Confirmation of the BRIGHT-4 Results.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.07.045","source_url":"https://doi.org/10.1016/j.jacc.2024.07.045","authors":["Gregg W Stone","Marco Valgimigli","David Erlinge","Yaling Han","Philippe Gabriel Steg","Rod H Stables","Enrico Frigoli","Stefan K James","Yi Li","Patrick Goldstein","Roxana Mehran","Ghazaleh Mehdipoor","Aaron Crowley","Shmuel Chen","Björn Redfors","Clayton Snyder","Zhipeng Zhou","Behnood Bikdeli"],"significance":7,"published":"2024-10-15","source_date":"2024-10-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/"],"congress":"","summary_en":"Confirmatory analysis of BRIGHT-4 validated that bivalirudin reduces mortality and bleeding compared with heparin during primary PCI for STEMI, strengthening the evidence for bivalirudin as the preferred anticoagulant in high-risk primary PCI.","created":"2026-07-03T10:31:14Z","updated":"2026-07-03T13:30:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Bevestiging van BRIGHT-4 resultaten: bivalirudine vermindert mortaliteit en bloedingen vergeleken met heparine bij STEMI en primaire PCI. Dit versterkt de positie van bivalirudine als eerstekeuze anticoagulans bij STEMI-PCI.","abstract_original":"BACKGROUND: In the BRIGHT-4 (Bivalirudin With Prolonged Full-Dose Infusion During Primary PCI Versus Heparin Trial-4), anticoagulation with bivalirudin plus a 2- to 4-hour high-dose infusion after percutaneous coronary intervention (PCI) reduced all-cause mortality and bleeding without increasing reinfarction or stent thrombosis compared with heparin alone in patients with ST-segment elevation myocardial infarction (STEMI). These findings require external validation. OBJECTIVES: This study sought to determine outcomes of bivalirudin vs heparin anticoagulation during PCI in STEMI. METHODS: We performed an individual-patient-data meta-analysis of all large randomized trials of bivalirudin vs heparin in STEMI patients undergoing primary PCI performed before BRIGHT-4. The primary endpoint was all-cause mortality. RESULTS: Six trials randomizing 15,254 patients were included. Pooled across all regimens of bivalirudin and glycoprotein IIb/IIIa inhibitor (GPI) use, bivalirudin reduced 30-day all-cause mortality (2.5% vs 2.9%; adjusted OR: 0.78; 95% CI: 0.62-0.99), cardiac mortality (adjusted OR: 0.69; 95% CI: 0.54-0.88), and major bleeding (adjusted OR: 0.53; 95% CI: 0.44-0.64) but increased reinfarction (adjusted OR: 1.30; 95% CI: 1.02-1.65) and stent thrombosis (adjusted OR: 1.43; 95% CI: 1.05-1.93) compared with heparin. In 4 trials in which 6,244 patients were randomized to bivalirudin plus a high-dose post-PCI infusion vs heparin without planned GPI use (the BRIGHT-4 regimens), 30-day all-cause mortality occurred in 1.8% vs 2.9% of patients, respectively (adjusted OR: 0.74; 95% CI: 0.48-1.12), and bivalirudin reduced cardiac mortality (adjusted OR: 0.62; 95% CI: 0.39-0.97) and major bleeding (adjusted OR: 0.49; 95% CI: 0.35-0.70), with similar rates of reinfarction (adjusted OR: 0.89; 95% CI: 0.58-1.38) and stent thrombosis (adjusted OR: 0.80; 95% CI: 0.41-1.57). CONCLUSIONS: In STEMI patients undergoing primary PCI, bivalirudin with a 2- to 4-hour post-PCI high-dose infusion reduced cardiac mortality and major bleeding without an increase in ischemic events compared with heparin monotherapy with provisional GPI use, confirming the BRIGHT-4 results."}