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.
Resumen
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).
Por qué esto importa para la hirudoterapia
Este metaanálisis de 8 ensayos controlados aleatorizados (27 491 pacientes con síndrome coronario agudo) examinó si la combinación de la anticoagulación basada en bivalirudina con el acceso arterial radial proporcionaba una reducción aditiva del riesgo de hemorragia en comparación con el uso de cualquiera de las dos estrategias de forma aislada. La bivalirudina es un inhibidor directo de la trombina sintético modelado estructuralmente sobre la hirudina, el anticoagulante característico del secretoma de la sanguijuela medicinal, por lo que los datos de desenlaces clínicos sobre la bivalirudina resultan informativos para comprender cómo se comporta y se optimiza en la práctica la farmacología anticoagulante derivada de la sanguijuela. El análisis halló que la bivalirudina redujo la hemorragia mayor únicamente con el acceso femoral (OR 0,51; p < 0,001), mientras que el acceso radial redujo la hemorragia solo con heparina; combinar ambas estrategias no ofreció ningún beneficio adicional, y no hubo diferencias en los eventos cardiovasculares adversos mayores (MACE) ni en la mortalidad por todas las causas. Una advertencia importante es que estos hallazgos son específicos de la anticoagulación periprocedimiento en el cateterismo cardíaco y no abordan directamente otros terapéuticos derivados de la hirudina ni contextos más amplios de hirudoterapia.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026