Meta-Analysis of Effects of Bivalirudin Versus Heparin on Myocardial Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention.
Review published in The American journal of cardiology (2016)
Abstract
Bivalirudin is an alternative to unfractionated heparin (UFH) anticoagulation during percutaneous coronary intervention. Previously, we have reported clinical benefit on major bleeding in favor of bivalirudin compared with UFH monotherapy but inconclusive results on mortality. Controversial data have been reported in the last 2 years. We conducted an updated meta-analysis including randomized trials and observational studies, which evaluated ischemic and bleeding outcomes for bivalirudin compared with UFH-only during percutaneous coronary intervention. We included 18 observational studies and 12 randomized trials published from 2003 to 2015. Primary outcomes were major adverse cardiovascular events within 30 days including death, myocardial infarction, and urgent revascularization and stent thrombosis, major bleeding, and transfusion. Overall, we found a significant risk reduction with bivalirudin for major bleeding (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.49 to 0.71, p <0.0001) and for transfusion (OR 0.79, 95% CI 0.66 to 0.95, p = 0.01) and similar risk for major adverse cardiovascular events (OR 0.98, 95% CI 0.86 to 1.12, p = 0.80). However, there was a substantial increased risk of stent thrombosis associated with bivalirudin (OR 1.52, 95% CI 1.11 to 2.08, p = 0.009). No impact on mortality was found. Meta-regression analyses on major bleeding suggested that bivalirudin was more effective than UFH at doses >60 IU/kg and independent of radial access. In conclusion, compared with UFH monotherapy, bivalirudin remains associated with less bleeding risk but higher stent thrombosis risk. Further study remains required to define its role in current antithrombotic armamentarium.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Bivalirudin is an alternative to unfractionated heparin (UFH) anticoagulation during percutaneous coronary intervention. Previously, we have reported clinical benefit on major bleeding in favor of bivalirudin compared with UFH monotherapy but inconclusive results on mortality.
Por qué esto importa para la hirudoterapia
Este metaanálisis actualizado de 30 estudios (18 observacionales, 12 aleatorizados; 2003–2015) comparó la bivalirudina con la monoterapia con heparina no fraccionada durante la intervención coronaria percutánea, encontrando una reducción significativa del riesgo de sangrado mayor y de transfusión con bivalirudina, pero un aumento del riesgo de trombosis del stent y sin impacto sobre la mortalidad. Para ASH, esto es directamente relevante porque la bivalirudina es un inhibidor directo de la trombina derivado de la hirudina —el anticoagulante característico de la saliva de la sanguijuela medicinal— por lo que la evidencia clínica a gran escala sobre su perfil beneficio-riesgo ayuda a ilustrar cómo se comporta un anticoagulante inspirado en el secretoma de la sanguijuela en la cardiología intervencionista moderna. Una salvedad honesta es que el análisis mezcla diseños aleatorizados y observacionales y los autores señalan que su papel en la práctica actual aún requiere más estudio; además, los desenlaces con un análogo sintético de la hirudina no demuestran directamente la eficacia ni la seguridad de la hirudoterapia con sanguijuelas vivas.
Citación
Meta-Analysis of Effects of Bivalirudin Versus Heparin on Myocardial Ischemic and Bleeding Outcomes After Percutaneous Coronary Intervention.
Barria Perez et al. · The American journal of cardiology, 2016
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026