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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este metaanálisis de 14 ensayos controlados aleatorizados (30.446 pacientes) comparó la bivalirudina con el uso provisional de inhibidores de la glucoproteína IIb/IIIa frente a la heparina con uso provisional o rutinario de GPI para la intervención coronaria percutánea. Los resultados agrupados a 30 días no mostraron diferencias significativas en muerte o infarto de miocardio entre los grupos, pero la bivalirudina se asoció con una mayor trombosis temprana del stent (especialmente en ICP primaria) y con un menor sangrado mayor y sangrado mayor según TIMI en comparación con la heparina. El propio resumen no menciona la hirudina, las sanguijuelas ni ningún componente derivado de sanguijuelas, y no caracteriza la relación de la bivalirudina con la hirudina. En consecuencia, no puede establecerse una conexión defendible con la hirudoterapia, el secretoma de la sanguijuela o el ámbito de la ASH únicamente a partir de esta fuente.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026