Bivalirudin Versus Heparin in Low and Non-Low Bleeding Risk Patients Undergoing Primary PCI for STEMI: The BRIGHT-4 Trial.
J Am Coll CardiolAug 28, 2026 (epub)
Clinical ResearchCardiology
Miaohan Qiu, Yixuan Duan, Xiaojian Feng et al.
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In 30 seconds
The BRIGHT-4 trial, a randomized controlled trial involving 6,016 STEMI patients undergoing primary PCI, compared bivalirudin with heparin. Bivalirudin significantly reduced the 30-day primary composite outcome of all-cause death or BARC types 3 to 5 bleeding, particularly in low bleeding risk patients (1.4% vs 2.9%; HR: 0.49).
Key findings
- In non-low bleeding risk patients, the primary outcome occurred in 8.6% vs 2.2% (HR: 4.08).
- Bivalirudin reduced the primary outcome in low bleeding risk patients to 1.4% compared to 2.9% with heparin.
- The difference in primary outcome for bivalirudin vs heparin in non-low bleeding risk patients was -1.1% (95% CI: -4.0% to 1.8%).
- The effects of bivalirudin on all-cause death were similar in both low and non-low bleeding risk patients.
Why it matters
This study highlights the effectiveness of bivalirudin in reducing major adverse outcomes in STEMI patients undergoing PCI, regardless of bleeding risk, which may influence anticoagulation strategies in clinical practice.