Comprehensive meta-analysis of safety and efficacy of bivalirudin versus heparin with or without routine glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndrome
Systematic review published in JACC. Cardiovascular interventions (2014)
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS). BACKGROUND: Bivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear. METHODS: A total of 13 randomized, controlled trials involving 24,605 patients were included. RESULTS: There was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly. CONCLUSIONS: Overall, bivalirudin in ACS patients is associated with a significant reduction of major bleeding compared with heparin plus routinely administered GPI, but with a marked increase in ST rates compared with heparin with or without GPI.
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 compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS).
Why This Matters for Hirudotherapy
This meta-analysis (publication type: Meta-Analysis) pooled 13 randomized controlled trials (24,605 patients) comparing 30-day safety and efficacy of bivalirudin versus heparin with or without routine glycoprotein IIb/IIIa inhibitors (GPI) in acute coronary syndrome patients. Bivalirudin showed no significant difference in mortality or myocardial infarction versus heparin, but demonstrated a significant reduction in major bleeding compared with heparin plus routine GPI (OR 0.52), alongside a marked increase in stent thrombosis rates, particularly acute stent thrombosis (≤24 h), which was approximately 4.5-fold higher. The abstract does not mention leeches, hirudin, or hirudotherapy; its relevance to ASH's domain is therefore not established by the source text, as it concerns pharmaceutical anticoagulation in cardiology.
Citation
Comprehensive meta-analysis of safety and efficacy of bivalirudin versus heparin with or without routine glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndrome
Navarese EP et al. · JACC. Cardiovascular interventions, 2014
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