Individual Patient Data Pooled Analysis of Randomized Trials of Bivalirudin versus Heparin in Acute Myocardial Infarction: Rationale and Methodology
Systematic review published in Thromb Haemost (2019)
Abstract
BACKGROUND: Individual randomized controlled trials (RCTs) of periprocedural anticoagulation with bivalirudin versus heparin during percutaneous coronary intervention (PCI) have reported conflicting results. Study-level meta-analyses lack granularity to adjust for confounders, explore heterogeneity, or identify subgroups that may particularly benefit or be harmed. OBJECTIVE: To overcome these limitations, we sought to develop an individual patient-data pooled database of RCTs comparing bivalirudin versus heparin. METHODS: We conducted a systematic review to identify RCTs in which ≥1,000 patients with acute myocardial infarction (AMI) undergoing PCI were randomized to bivalirudin versus heparin. RESULTS: From 738 identified studies, 8 RCTs met the prespecified criteria. The principal investigators of each study agreed to provide patient-level data. The data were pooled and checked for accuracy against trial publications, with discrepancies addressed by consulting with the trialists. Consensus-based definitions were created to resolve differing antithrombotic, procedural, and outcome definitions. The project required 3.5 years to complete, and the final database includes 27,409 patients (13,346 randomized to bivalirudin and 14,063 randomized to heparin). CONCLUSION: We have created a large individual patient database of bivalirudin versus heparin RCTs in patients with AMI undergoing PCI. This endeavor may help identify the optimal periprocedural anticoagulation regimen for patient groups with different relative risks of adverse ischemic versus bleeding events, including those with ST-segment and non-ST-segment elevation MI, radial versus femoral access, use of a prolonged bivalirudin infusion or glycoprotein inhibitors, and others. Adherence to standardized techniques and rigorous validation processes should increase confidence in the accuracy and robustness of the results.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Individual randomized controlled trials (RCTs) of periprocedural anticoagulation with bivalirudin versus heparin during percutaneous coronary intervention (PCI) have reported conflicting results.
Warum dies für die Hirudotherapie relevant ist
Dieser Artikel beschreibt die Rationale und Methodik zur Erstellung einer gepoolten Datenbank mit individuellen Patientendaten aus acht randomisierten kontrollierten Studien, die Bivalirudin versus Heparin bei 27.409 Patienten mit akutem Myokardinfarkt unter perkutaner Koronarintervention vergleichen. Die geplante Analyse zielt darauf ab, optimale periprozedurale Antikoagulationsstrategien über Subgruppen mit unterschiedlichen Blutungs- und Ischämierisiken hinweg zu identifizieren, einschließlich verschiedener MI-Typen, Zugangsstellen und pharmakologischer Regime. Das Abstract präsentiert keine Ergebnisse – es ist rein methodisch – und enthält keinerlei Erwähnung von Blutegeln, Hirudotherapie oder von Blutegeln stammenden Verbindungen. Aus diesem Abstract lässt sich keine verteidigbare Verbindung zum ASH-Gebiet herleiten, da es sich vollständig auf das Design einer klinischen Datenbank zum Vergleich zweier pharmazeutischer Antikoagulanzien konzentriert.
Zitation
Individual Patient Data Pooled Analysis of Randomized Trials of Bivalirudin versus Heparin in Acute Myocardial Infarction: Rationale and Methodology.
Bikdeli B et al. · Thromb Haemost, 2019
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