Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials
Meta-analysis published in Cardiovascular revascularization medicine : including molecular interventions (2014)
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. 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). 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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
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.
Warum dies für die Hirudotherapie relevant ist
Diese Metaanalyse von 14 randomisierten kontrollierten Studien (30.446 Patienten) verglich Bivalirudin mit bedarfsweisem Einsatz von Glykoprotein-IIb/IIIa-Inhibitoren versus Heparin mit bedarfsweisem oder routinemäßigem GPI-Einsatz bei perkutaner Koronarintervention. Die gepoolten 30-Tage-Endpunkte zeigten keinen signifikanten Unterschied zwischen den Gruppen hinsichtlich Tod oder Myokardinfarkt, jedoch war Bivalirudin im Vergleich zu Heparin mit einer höheren Rate früher Stentthrombosen (insbesondere bei primärer PCI) sowie mit weniger schweren und TIMI-schweren Blutungen assoziiert. Die Zusammenfassung selbst erwähnt weder Hirudin noch Blutegel oder eine aus Blutegeln stammende Komponente und charakterisiert die Beziehung von Bivalirudin zu Hirudin nicht. Dementsprechend lässt sich aus dieser Quelle allein keine vertretbare Verbindung zur Hirudotherapie, zum Blutegel-Sekretom oder zum ASH-Gebiet herleiten.
Zitation
Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials
Lipinski MJ et al. · Cardiovascular revascularization medicine : including molecular interventions, 2014
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