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.
Resumen
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).
Por qué esto importa para la hirudoterapia
Este metaanálisis de 13 ensayos controlados aleatorizados (24.605 pacientes) comparó la seguridad y la eficacia a 30 días de la bivalirudina frente a la heparina con o sin inhibidores de la glicoproteína IIb/IIIa de uso rutinario en el síndrome coronario agudo, sin encontrar diferencias significativas en mortalidad ni infarto de miocardio, con reducción de la hemorragia mayor frente a heparina más IGP de uso rutinario (OR 0,52, p<0,001), pero con aumento de la trombosis del stent, en particular la trombosis aguda del stent en las primeras 24 horas (~4,5 veces mayor). La bivalirudina es un inhibidor directo de la trombina modelado a partir de la hirudina, el potente anticoagulante presente en la saliva de la sanguijuela medicinal, por lo que estos datos cardiovasculares a gran escala son directamente relevantes para la ASH porque caracterizan los compromisos de eficacia y seguridad en el mundo real de una clase de fármacos derivados del secretoma de la sanguijuela. La advertencia honesta es que esto evalúa un análogo farmacéutico sintético de la hirudina en intervención coronaria percutánea, no la terapia con sanguijuelas ni el secretoma de la sanguijuela en sentido amplio; la señal de trombosis del stent también ilustra que la anticoagulación basada en hirudina conlleva riesgos dependientes del contexto que no pueden extrapolarse a la hirudoterapia con el organismo completo.
Citación
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
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026