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Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials.

by Lipinski, Michael J; Lhermusier, Thibault; Escarcega, Ricardo O; Baker, Nevin C; Magalhaes, Marco A; Torguson, Rebecca; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron.
Citation: Cardiovascular Revascularization Medicine. 15(6-7):315-22, 2014 Sep-Oct..Journal: Cardiovascular revascularization medicine : including molecular interventions.ISSN: 1878-0938.Full author list: Lipinski MJ; Lhermusier T; Escarcega RO; Baker NC; Magalhaes MA; Torguson R; Suddath WO; Satler LF; Pichard AD; Waksman R.UI/PMID: 25440505.Subject(s): Angioplasty, Balloon, Coronary | *Anticoagulants/tu [Therapeutic Use] | *Antithrombins/tu [Therapeutic Use] | Hemorrhage/ci [Chemically Induced] | *Heparin/tu [Therapeutic Use] | Hirudins | Humans | Myocardial Infarction/dt [Drug Therapy] | Odds Ratio | *Peptide Fragments/tu [Therapeutic Use] | Percutaneous Coronary Intervention/mt [Methods] | Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Platelet Glycoprotein GPIIb-IIIa Complex/tu [Therapeutic Use] | *Randomized Controlled Trials as Topic | Recombinant Proteins/tu [Therapeutic Use] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Comparative Study | Journal Article | Meta-AnalysisAbbreviated citation: Cardiovasc Revasc Med. 15(6-7):315-22, 2014 Sep-Oct.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: AIMS: Given controversy over anticoagulation regimens for percutaneous coronary intervention (PCI), we performed an updated meta-analysis of randomized controlled trials (RCTs) to compare bivalirudin versus heparin.Abstract: METHODS AND RESULTS: Medline/Pubmed and Cochrane CENTRAL were searched for all RCTs comparing bivalirudin with provisional glycoprotein IIb/IIIa inhibitor (GPI) use versus heparin with provisional or routine GPI use for PCI. Pooled estimates of 30day outcomes, presented as risk ratios (RR) [95% confidence intervals], were generated with random-effect models. Our analysis included 14 studies with 30,446 patients that were randomized to bivalirudin with provisional GPI use (n=14,869) versus heparin with provisional (n=6451) or routine GPI use (n=9126). There was no significant difference between anticoagulation with bivalirudin compared with heparin for death (RR 0.95 [0.78-1.14]) or myocardial infarction (RR 1.10 [0.97-1.25]). Early stent thrombosis was significantly greater with bivalirudin compared with heparin (RR 1.61 [1.18-2.20], p=0.003), especially in patients undergoing primary PCI (2.15 [1.15-4.03], p=0.02). However, bivalirudin reduced the risk of major bleeding (RR 0.59 [0.51-0.70], p<0.0001) and TIMI major bleeding (RR 0.59 [0.48-0.72], p<0.0001) compared with heparin. Meta-regression analysis demonstrated that bleeding risk with use of heparin significantly increases with increasing GPI use (p=0.02).Abstract: CONCLUSION: Meta-analysis of 14 RCTs with 30,446 patients demonstrated that bivalirudin is associated with higher risk of stent thrombosis but lower risk of major bleeding compared with heparin.Copyright © 2014. Published by Elsevier Inc.

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