The five-part Anticoagulation and Antiplatelet Strategies poll series attempted to examine use of anticoagulation with percutaneous coronary intervention (PCI) and how that may have changed in recent years. The response rate was modest and certainly does not represent a definitive profile of use; see the images below.

The following bullet points summarize the responses. Percentages are reported as rounded numbers:

• In routine PCI, 59% of respondents never used bivalirudin, while others "sometimes" use it. Only 8% responded that they always use bivalirudin.
• In ST-segment elevation myocardial infarction (STEMI), slightly more than half of respondents never use bivalirudin, and 15% always use it.
• In non-ST-segment elevation myocardial infarction (NSTEMI), three quarters of operators never continue bivalirudin after leaving the laboratory, with only 5% always continuing.
• In STEMI, 55% never continue bivalirudin post-catheterization laboratory, and 90% say the decision of whether to continue post-catheterization laboratory is not based on the length of the procedure.
• Overall, 50% of respondents' bivalirudin use has not changed over the last 2 years, while 40% report decreased use over the same time frame.
• For patients with both STEMI and NSTEMI who are receiving unfractionated heparin, three quarters of respondents report an activated clotting time target of 250 or 300, with a target of 250 predominating.
• Data from cangrelor use are too small to comment, which may reflect limited use.

Again, these surveys are limited in numbers but do raise some interesting questions, particularly regarding continued use of bivalirudin in patients with STEMI after leaving the laboratory and the possibility of procedure length not reflected in reported decision-making.¹

References

1. Tamez H, Pinto DS, Kirtane AJ, et al. Effect of Short Procedural Duration With Bivalirudin on Increased Risk of Acute Stent Thrombosis in Patients With STEMI: A Secondary Analysis of the HORIZONS-AMI Randomized Clinical Trial. JAMA Cardiol 2017;2:673-7.

Keywords: Antithrombins, Heparin, Myocardial Infarction, Peptide Fragments, Hirudins, Percutaneous Coronary Intervention, Catheterization, Anticoagulants, Angiography

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