Combined Use of Bivalirudin and Radial Access in Acute Coronary Syndromes IsNot Superior to the Use of Either OneSeparately: Meta-Analysis of Randomized Controlled Trials
Meta-analysis published in JACC. Cardiovascular interventions (2016)
Abstract
OBJECTIVES: The aim of this meta-analysis was to study the relation between access site and bivalirudin use on outcomes in patients with acute coronary syndrome (ACS). BACKGROUND: Bivalirudin and radial access use are 2 strategies that are increasingly used to lower major bleeding in patients with ACS undergoing invasive approaches. The interaction between these 2 strategies and the benefit of using them in combination are unclear. METHODS: This analysis included randomized controlled trials that compared bivalirudin to heparin with or without glycoprotein IIb/IIIa inhibitors in patients with ACS and reported outcomes stratified by arterial access site. Meta-analyses of outcome data were performed on the basis of access site and anticoagulation regimen. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from event rates using random-effects models. RESULTS: Eight trials with a total of 27,491 patients were included. Bivalirudin reduced major bleeding risk in patients with femoral access (OR: 0.51; 95% CI: 0.46 to 0.6; p < 0.001) but not in patients with radial access (OR: 0.75; 95% CI: 0.45 to 1.26; p = 0.28). Moreover, radial access reduced major bleeding risk in patients treated with heparin (OR: 0.57; 95% CI: 0.43 to 0.77; p < 0.001) but not in patients treated with bivalirudin (OR: 0.96; 95% CI: 0.65 to 1.41; p = 0.83). There were no differences in major adverse cardiovascular events or all-cause mortality between bivalirudin and heparin, regardless of access site. CONCLUSIONS: Bivalirudin reduces bleeding risk only with femoral access, and radial access reduces bleeding risk only with heparin anticoagulation. Therefore, there is no additional benefit to the combined use of bivalirudin and radial access strategies in patients with ACS.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
The aim of this meta-analysis was to study the relation between access site and bivalirudin use on outcomes in patients with acute coronary syndrome (ACS).
Why This Matters for Hirudotherapy
This meta-analysis of 8 randomized controlled trials (27,491 patients with acute coronary syndrome) examined whether combining bivalirudin-based anticoagulation with radial arterial access provided additive bleeding-risk reduction compared with using either strategy alone. Bivalirudin is a synthetic direct thrombin inhibitor structurally modeled on hirudin, the signature anticoagulant of the medicinal leech secretome, so clinical outcome data on bivalirudin are informative for understanding how leech-derived anticoagulant pharmacology performs and is optimized in practice. The analysis found bivalirudin reduced major bleeding only with femoral access (OR 0.51; p < 0.001), while radial access reduced bleeding only with heparin; combining both offered no additional benefit, and there were no differences in major adverse cardiovascular events or all-cause mortality. An important caveat is that these findings are specific to periprocedural anticoagulation in cardiac catheterization and do not directly address other hirudin-derived therapeutics or broader hirudotherapy contexts.
Citation
Combined Use of Bivalirudin and Radial Access in Acute Coronary Syndromes IsNot Superior to the Use of Either OneSeparately: Meta-Analysis of Randomized Controlled Trials
Mina GS et al. · JACC. Cardiovascular interventions, 2016
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