Periprocedural antithrombotic strategies in acute coronary syndromes undergoing percutaneous coronary intervention: Have we discarded bivalirudin too soon?

Network meta-analysis published in Cardiovasc Revasc Med (2023)

Última actualización: 18 de junio de 2026Revisado por: ASH Editorial Board

Artículo de investigación — revisión de evidenciaReferencia del artículo

Evidence: Research reportDesarrollo de fármacosEnsayos clínicosBenenati S et al. · Cardiovasc Revasc Med, 2023

Abstract

BACKGROUND: Publication of the BRIGHT-4 trial results has restimulated discussion about the optimal periprocedural antithrombotic strategy for patients undergoing percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS). It is possible that variation in the infusion duration, may contribute to observed differences in safety-efficacy profiles of bivalirudin in this clinical setting. METHODS: Up to December 2022, randomized controlled trials (RCTs) comparing bivalirudin (either administered peri-procedurally or accompanied by postprocedural infusion) and heparin, both with or without GPI, were searched and entered in a frequentist network meta-analysis. Co-primary endpoints were trial-defined major adverse composite events (MACE) and major bleeding. Incident rate ratios (IRR) and 95 % confidence intervals (CI) were estimated. RESULTS: 10 RCTs (N = 57,137 patients/month) were included. As compared to heparin, prolonged bivalirudin infusion resulted in lower rates of major bleeding (IRR 0.58, 95 % CI 0.36-0.91), but there was no differences in MACE rates between these strategies. With regard to NACE, prolonged bivalirudin infusion yielded lower risk (IRR 0.86, 95 % CI 0.77-0.96), whereas both bivalirudin and heparin increased risk when coupled with GPI (IRR 1.24, 95 % CI 1.01-1.51 and IRR 1.24, 95 % CI 1.06-1.44, respectively). Both these combination strategies also increased minor bleeding rates (IRR 1.49, 95 % CI 1.16-1.93 and IRR 1.58, 95 % CI 1.29-1.95, respectively, for bivalirudin and heparin). Results were consistent across several sensitivity analyses. CONCLUSION: In patients with ACS undergoing PCI, procedural bivalirudin administration followed by prolonged infusion results in lower major bleeding rates, but there does not appear to be a difference in observed MACE.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleNetwork Meta-AnalysisResearch Support, Non-U.S. Gov't

Indexed MeSH termsHumansAntithrombinsFibrinolytic AgentsAcute Coronary SyndromeTreatment OutcomeHeparinHirudinsPeptide FragmentsHemorrhagePercutaneous Coronary InterventionRecombinant ProteinsAnticoagulants

Resumen

Network meta-analysis of 10 RCTs (n=57137) comparing bivalirudin and heparin; prolonged bivalirudin infusion reduced major bleeding (IRR 0.58) without increasing MACE.

Por qué esto importa para la hirudoterapia

Este metanálisis en red de 10 ensayos controlados aleatorizados (N=57.137) comparó bivalirudina periprocedimiento frente a heparina en pacientes con síndromes coronarios agudos sometidos a intervención coronaria percutánea. La infusión prolongada de bivalirudina se asoció con tasas más bajas de sangrado mayor y menor riesgo neto de eventos clínicos adversos en comparación con la heparina, sin diferencias significativas en los eventos adversos compuestos mayores. El resumen no contiene discusión sobre sanguijuelas, hirudina o hirudoterapia, y no formula ninguna afirmación de relación mecanística o conceptual entre la bivalirudina y los anticoagulantes derivados de sanguijuela. Por lo tanto, su relevancia para el ámbito de la ASH es mínima o nula basándose únicamente en la información proporcionada en el resumen de la fuente.