Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: A meta-analysis of randomized clinical trials |
| |
Authors: | Michael S. Lee Hsini LiaoTae Yang Jashdeep Dhoot Jonathan Tobis Gregg Fonarow Ehtisham Mahmud |
| |
Affiliation: | a David Geffen School of Medicine at University of California, Los Angeles (Division of Cardiology), Los Angeles, CA, United Statesb Boston Scientific Corporation, Maple Grove, MN, United Statesc University of California, San Diego (Division of Cardiology), San Diego, CA, United Statesd Boston Scientific Corporation, Marlborough, MA, United States |
| |
Abstract: | ObjectiveThis meta-analysis was performed to assess the efficacy and safety of bivalirudin compared with unfractionated heparin or enoxaparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI).BackgroundPharmacotherapy for patients undergoing PCI includes bivalirudin, heparin, and GP IIb/IIIa inhibitors. We sought to compare ischemic and bleeding outcomes with bivalirudin versus heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI.MethodsA literature search was conducted to identify fully published randomized trials that compared bivalirudin with heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI.ResultsA total of 19,772 patients in 5 clinical trials were included in the analysis (9785 patients received bivalirudin and 9987 patients received heparin plus GP IIb/IIIa inhibitors during PCI). Anticoagulation with bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in no difference in major adverse cardiovascular events (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.96 to 1.19), death (OR 0.93, 95% CI 0.72 to 1.21), or urgent revascularization (OR 1.06, 95% CI 0.86 to 1.30). There is a trend towards a higher risk of myocardial infarction (OR 1.12, 95% CI 0.99 to 1.28) but a significantly lower risk of TIMI major bleeding with bivalirudin (OR 0.55, 95% CI 0.44 to 0.69).ConclusionIn patients who undergo PCI, anticoagulation with bivalirudin as compared with unfractionated heparin or enoxaparin plus GP IIb/IIIa inhibitors results in similar ischemic adverse events but a reduction in major bleeding. |
| |
Keywords: | ACT, activated clotting time ACUITY, Acute Catheterization and Urgent Intervention Triage Strategy CACHET, Comparison of Abciximab Complications with Hirulog for Ischemic Events Trial GP, glycoprotein HORIZONS-AMI, Harmonizing Outcomes with RevascularizatiON and Stents in Acute Myocardial Infarction PCI, percutaneous coronary intervention PROTECT-TIMI-30, Randomized Trial to Evaluate the Relative PROTECTion against Post-PCI Microvascular Dysfunction and Post-PCI Ischemia among Anti-Platelet and Anti-Thrombotic Agents&mdash Thrombolysis in Myocardial Infarction-30 REPLACE-2, Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events TIMI, Thrombolysis in Myocardial Infarction |
本文献已被 ScienceDirect 等数据库收录! |
|