Periprocedural antithrombotic strategies in acute coronary syndromes undergoing percutaneous coronary intervention: Have we discarded bivalirudin too soon?

Network meta-analysis published in Cardiovasc Revasc Med (2023)

Zuletzt aktualisiert: 18. Juni 2026Geprüft von: ASH Editorial Board

Forschungsartikel – EvidenzreviewArtikelreferenz

Evidence: Research reportArzneimittelentwicklungKlinische StudienBenenati S et al. · Cardiovasc Revasc Med, 2023

Abstract

BACKGROUND: Publication of the BRIGHT-4 trial results has restimulated discussion about the optimal periprocedural antithrombotic strategy for patients undergoing percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS). It is possible that variation in the infusion duration, may contribute to observed differences in safety-efficacy profiles of bivalirudin in this clinical setting. METHODS: Up to December 2022, randomized controlled trials (RCTs) comparing bivalirudin (either administered peri-procedurally or accompanied by postprocedural infusion) and heparin, both with or without GPI, were searched and entered in a frequentist network meta-analysis. Co-primary endpoints were trial-defined major adverse composite events (MACE) and major bleeding. Incident rate ratios (IRR) and 95 % confidence intervals (CI) were estimated. RESULTS: 10 RCTs (N = 57,137 patients/month) were included. As compared to heparin, prolonged bivalirudin infusion resulted in lower rates of major bleeding (IRR 0.58, 95 % CI 0.36-0.91), but there was no differences in MACE rates between these strategies. With regard to NACE, prolonged bivalirudin infusion yielded lower risk (IRR 0.86, 95 % CI 0.77-0.96), whereas both bivalirudin and heparin increased risk when coupled with GPI (IRR 1.24, 95 % CI 1.01-1.51 and IRR 1.24, 95 % CI 1.06-1.44, respectively). Both these combination strategies also increased minor bleeding rates (IRR 1.49, 95 % CI 1.16-1.93 and IRR 1.58, 95 % CI 1.29-1.95, respectively, for bivalirudin and heparin). Results were consistent across several sensitivity analyses. CONCLUSION: In patients with ACS undergoing PCI, procedural bivalirudin administration followed by prolonged infusion results in lower major bleeding rates, but there does not appear to be a difference in observed MACE.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleNetwork Meta-AnalysisResearch Support, Non-U.S. Gov't

Indexed MeSH termsHumansAntithrombinsFibrinolytic AgentsAcute Coronary SyndromeTreatment OutcomeHeparinHirudinsPeptide FragmentsHemorrhagePercutaneous Coronary InterventionRecombinant ProteinsAnticoagulants

Zusammenfassung

Network meta-analysis of 10 RCTs (n=57137) comparing bivalirudin and heparin; prolonged bivalirudin infusion reduced major bleeding (IRR 0.58) without increasing MACE.

Warum dies für die Hirudotherapie relevant ist

Diese Netzwerk-Metaanalyse von 10 randomisierten kontrollierten Studien (N = 57.137) verglich periprozedurales Bivalirudin mit Heparin bei Patienten mit akuten Koronarsyndromen, die sich einer perkutanen Koronarintervention unterzogen. Eine verlängerte Bivalirudin-Infusion war im Vergleich zu Heparin mit niedrigeren Raten schwerer Blutungskomplikationen und einem geringeren Risiko für unerwünschte klinische Nettoereignisse assoziiert, ohne dass ein signifikanter Unterschied bei den schwerwiegenden unerwünschten Komposit-Ereignissen bestand. Das Abstract enthält keine Erörterung von Egeln, Hirudin oder Hirudotherapie und stellt keinerlei mechanistischen oder konzeptionellen Zusammenhang zwischen Bivalirudin und aus Egeln gewonnenen Antikoagulanzien her. Die Relevanz für den Zuständigkeitsbereich von ASH ist daher – allein auf Grundlage der im Quell-Abstract enthaltenen Informationen – minimal bis nicht gegeben.