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.
Резюме
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).
Почему это важно для гирудотерапии
This meta-analysis of eight randomized controlled trials (27,491 patients) evaluated the interaction between arterial access site and bivalirudin use on outcomes in patients with acute coronary syndrome undergoing invasive management. Bivalirudin reduced major bleeding only with femoral access, while radial access reduced major bleeding only with heparin anticoagulation; no differences in major adverse cardiovascular events or all-cause mortality were observed between bivalirudin and heparin regardless of access site. The authors concluded there is no additional benefit to combining bivalirudin and radial access strategies. The abstract contains no mention of hirudin, leeches, leech-derived components, or hirudotherapy. Consequently, no defensible connection to ASH's domain or the leech secretome can be drawn from this source alone.
Цитирование
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
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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