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

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Citation: Cardiovascular Revascularization Medicine. 15(6-7):315-22, 2014 Sep-Oct.PMID: 25440505Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Meta-AnalysisSubject headings: *Anticoagulants/tu [Therapeutic Use] | *Antithrombins/tu [Therapeutic Use] | *Heparin/tu [Therapeutic Use] | *Peptide Fragments/tu [Therapeutic Use] | *Randomized Controlled Trials as Topic | Angioplasty, Balloon, Coronary | Hemorrhage/ci [Chemically Induced] | Hirudins | Humans | Myocardial Infarction/dt [Drug Therapy] | Odds Ratio | Percutaneous Coronary Intervention/mt [Methods] | Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Platelet Glycoprotein GPIIb-IIIa Complex/tu [Therapeutic Use] | Recombinant Proteins/tu [Therapeutic Use] | Treatment OutcomeYear: 2014Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: 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.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.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).All authors: Baker NC, Escarcega RO, Lhermusier T, Lipinski MJ, Magalhaes MA, Pichard AD, Satler LF, Suddath WO, Torguson R, Waksman RFiscal year: FY2015Date added to catalog: 2016-05-24
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Item type Current library Call number Status Date due Barcode
Journal Article MedStar Authors Catalog 25440505 Available 25440505

Available in print through MWHC library: 2002 - present

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.

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.

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).

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