Efficacy and safety of bivalirudin for percutaneous coronary intervention in acute coronary syndromes: a meta-analysis of randomized-controlled trials
Review published in Clinical research in cardiology : official journal of the German Cardiac Society (2018)
Abstract
AIMS: The efficacy and safety of bivalirudin in patients undergoing percutaneous coronary intervention (PCI) for treatment of acute coronary syndromes (ACS) remains controversial despite recent evidence from large randomized-controlled trials (RCTs). Thus, this systematic review and meta-analysis sought to investigate the efficacy and safety of bivalirudin as compared to heparin in patients with ACS undergoing PCI. METHODS AND RESULTS: Medline/PubMed, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov databases were searched for RCTs. Primary endpoint was MACE consisting of all-cause death, myocardial infarction, and stroke within 30 days. Secondary endpoints were components of the primary endpoint and stent thrombosis. The primary safety endpoint was major bleeding. We identified 12 RCTs comprising 33,844 patients. Between bivalirudin and heparin, there were no significant differences for MACE (OR 1.06; 95% CI 0.96-1.17; p = 0.24), death, myocardial infarction, and stent thrombosis. Similar results were seen following stratification by use of glycoprotein inhibitors (GPI). Major bleeding trended to be less frequent in patients treated with bivalirudin. However, no safety benefit for bivalirudin was seen when use of GPI was balanced between groups (OR 0.88; 95% CI 0.67-1.16; p = 0.35; p for heterogeneity < 0.01). CONCLUSIONS: Compared with heparin, bivalirudin was associated with a similar incidence of ischemic events following PCI for ACS. An association of bivalirudin with decreased bleeding was not seen with balanced use of GPI.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
The efficacy and safety of bivalirudin in patients undergoing percutaneous coronary intervention (PCI) for treatment of acute coronary syndromes (ACS) remains controversial despite recent evidence from large randomized-controlled trials (RCTs).
Por qué esto importa para la hirudoterapia
Esta revisión sistemática y metaanálisis de 12 ensayos controlados aleatorizados (33.844 pacientes) comparó la bivalirudina con la heparina en pacientes con síndromes coronarios agudos sometidos a intervención coronaria percutánea, encontrando que no hubo diferencia significativa en los eventos cardiovasculares adversos mayores (OR 1,06; IC 95% 0,96-1,17) y sugiriendo que la aparente ventaja hemorrágica de la bivalirudina no se observó cuando el uso de inhibidores de la glicoproteína se equilibró entre los grupos. La bivalirudina es un inhibidor directo sintético de la trombina modelado estructuralmente sobre la hirudina, el anticoagulante de la saliva de la sanguijuela medicinal, por lo que este estudio es relevante para comprender cómo se comporta un anticoagulante inspirado en el secretoma de la sanguijuela en la cardiología intervencionista contemporánea. Sin embargo, se trata de una evaluación de un producto farmacéutico específico en ICP más que de un estudio sobre la terapia con sanguijuelas en sí, y sus hallazgos no pueden extrapolarse directamente a la hirudoterapia ni al secretoma de la sanguijuela en su conjunto.
Citación
Efficacy and safety of bivalirudin for percutaneous coronary intervention in acute coronary syndromes: a meta-analysis of randomized-controlled trials
Nhrenberg TG et al. · Clinical research in cardiology : official journal of the German Cardiac Society, 2018
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026