HEAT-PPCI and BRIGHT
Dr Nick Cruden presents a trial update on HEAT-PPCI and BRIGHT.
Both trials investigated the optimal anti-thrombotic strategy, specifically heparin and bivalirudin.
In HEAT-PPCI (Liverpool), a single-centre open label RCT recruited patients with STEMI and they were randomised to either bivalirudin or heparin. This study favoured heparin use over bivalirudin from a reduction in primary composite endpoint, driven by a reduction in re-infarction due to acute stent thrombosis.
The BRIGHT Trial (China), a multi-centre open label RCT enrolled patients with ACS (predominantly STEMI) randomised patients to either bivalirudin (± tirofiban) or heparin (± tirofiban) or heparin + tirofiban. The authors found a reduction in composite endpoint favouring bivalirudin driven by a reduction in bleeding.
Dr Cruden attempts to reconcile these divergent findings.