Effect of post-primary percutaneous coronary intervention bivalirudin infusion on net adverse clinical events and mortality: A comprehensive pairwise and network meta-analysis of randomized controlled trials
Meta-analysis published in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2016)
Abstract
OBJECTIVE: To compare the efficacies of various post-percutaneous coronary intervenetion (PCI) bivalirudin doses on net adverse clinical events (NACEs) and mortality. BACKGROUND: In primary PCI, lower risk of bleeding with bivalirudin (vs. unfractionated heparin [UFH]) is counterbalanced by an increased risk of acute stent thrombosis (ST). Several randomized clinical trials (RCTs) and a recent meta-analysis suggest that acute ST risk may be eliminated without compromising the bleeding benefit, but only if the full dose, not a low dose, of bivalirudin is continued post-PCI. However, it is not known whether this improved risk leads to lower rates of NACEs and mortality. METHODS: Scientific databases and Web sites were searched for RCTs. Trials were included if study patients were undergoing primary PCI for acute ST-segment elevation myocardial infarction and were randomly assigned to bivalirudin or UFH treatment. The bivalirudin arm was divided based on post-PCI bivalirudin dosage: The Biv-Full group received 1.75 mg/kg/h, the Biv-Low group, 0.25 mg/kg/h, and the Biv-No group, none. RESULTS: Six RCTs involving 16,842 patients were found. In pairwise meta-analysis, bivalirudin improved 30-day all-cause mortality by 35% and cardiac mortality by 32%, but did not yield a NACE rate better than that achieved with UFH. Subgroup analysis showed the Biv-Full group had a 46% lower NACE rate and 47% lower all-cause mortality than UFH. These effects were not seen in the other two groups. Network meta-analysis yielded similar results. At treatment ranking, the Biv-Full group yielded the best treatment efficacy. CONCLUSIONS: In primary PCI, full-dose bivalirudin infusion for 3-4 hr after PCI appeared to improve NACE rates compared to UFH. It also seemed to be the most effective strategy for improving cardiac mortality and all-cause mortality. © 2016 Wiley Periodicals, Inc.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
To compare the efficacies of various post-percutaneous coronary intervenetion (PCI) bivalirudin doses on net adverse clinical events (NACEs) and mortality.
Por qué esto importa para la hirudoterapia
Este metaanálisis por pares y en red de seis ensayos controlados aleatorizados (16.842 pacientes sometidos a ICP primaria por infarto de miocardio con elevación del segmento ST) comparó las estrategias de dosificación de bivalirudina postprocedimiento frente a heparina no fraccionada, hallando que la infusión de bivalirudina a dosis completa post-ICP (1,75 mg/kg/h durante 3–4 horas) se clasificó como la mejor en eficacia de tratamiento, con un 46% menos de tasas de eventos clínicos adversos netos y un 47% menos de mortalidad por todas las causas frente a HNF en el análisis de subgrupos. La bivalirudina es un inhibidor directo sintético de la trombina modelado a partir de la hirudina, el anticoagulante distintivo de la saliva de la sanguijuela medicinal, lo que hace que estos desenlaces cardiovasculares sean directamente relevantes para el secretoma de la sanguijuela y para el interés de la ASH en los terapéuticos derivados de la hirudina. El estudio ilustra cómo un anticoagulante inspirado en la saliva de la sanguijuela continúa siendo refinado en la cardiología intervencionista moderna. Una salvedad importante es que los hallazgos estratificados por dosis derivan de contrastes de subgrupos más que de contrastes aleatorizados directos, y las estimaciones agrupadas siguen siendo vulnerables a la heterogeneidad entre ensayos en los regímenes antitrombóticos concomitantes.
Citación
Effect of post-primary percutaneous coronary intervention bivalirudin infusion on net adverse clinical events and mortality: A comprehensive pairwise and network meta-analysis of randomized controlled trials
Shah R et al. · Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2016
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026