Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: A meta-analysis of randomised trials
Cassese S, Byrne RA, Laugwitz KL, Schunkert H, Berger PB, Kastrati A (2015)
Publication Type: Journal article
Publication year: 2015
Journal
Book Volume: 11
Pages Range: 196-203
Journal Issue: 2
DOI: 10.4244/EIJY14M08_01
Abstract
Aims: Current recommendations on the use of bivalirudin in patients treated with percutaneous coronary intervention (PCI) are mostly based on trials comparing bivalirudin versus heparin plus planned glycoprotein IIb/IIIa inhibitor (GPI). Whether bivalirudin is also superior to heparin alone is still not well established. This meta-analysis investigates the efficacy and safety of bivalirudin versus heparin in patients treated with PCI without planned use of GPI. Methods and results: Scientific databases and websites were searched for randomised controlled trials. The primary efficacy and safety outcomes were the 30-day incidence of death and major bleeding, respectively. The secondary outcomes were the 30-day incidence of myocardial infarction (MI), definite stent thrombo-sis (ST), urgent target vessel revascularisation (TVR), and overall death at the longest available follow-up. Odds ratio (OR) and 95% confidence interval (95% CI) served as summary statistics. Ten trials were identi-fied including a total of 18,065 PCI patients randomised to bivalirudin (n=9,033) versus heparin (n=9,032). At 30 days, bivalirudin versus heparin showed a comparable risk of death (1.09 [0.83-1.41], p=0.54), and MI (1.10 [0.83-1.46], p=0.50) with a trend towards a higher risk of urgent TVR (1.37 [0.96-1.96], p=0.08). The risk of major bleeding was lower with bivalirudin (0.57 [0.40-0.80], p=0.001) and the bleeding reduction was more evident when high doses of heparin were used as comparator (p for interaction <0.001). The risk of definite ST (2.09 [1.26-3.47], p=0.005) and, in particular, the risk of acute ST (3.48 [1.66-7.28], p<0.001) was increased by bivalirudin. Conclusions: Patients undergoing PCI randomised to therapy with either bivalirudin or heparin display a similar mortality. Bivalirudin as compared to heparin appears to reduce the risk of major bleeding at the expense of a higher risk of acute ST.
Involved external institutions
Germany (DE)
United States (USA) (US)How to cite
APA:
Cassese, S., Byrne, R.A., Laugwitz, K.-L., Schunkert, H., Berger, P.B., & Kastrati, A. (2015). Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: A meta-analysis of randomised trials. EuroIntervention, 11(2), 196-203. https://doi.org/10.4244/EIJY14M08_01
MLA:
Cassese, Salvatore, et al. "Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: A meta-analysis of randomised trials." EuroIntervention 11.2 (2015): 196-203.
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