NYMC Faculty Publications

Meta-Analysis of Randomized Clinical Trials Comparing Bivalirudin Versus Heparin Plus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention and in Patients With ST-Segment Elevation Myocardial Infarction

Author Type(s)

Faculty

DOI

10.1016/j.amjcard.2014.04.033

Journal Title

The American Journal of Cardiology

First Page

250

Last Page

259

Document Type

Article

Publication Date

7-15-2014

Department

Medicine

Keywords

Anticoagulants, Antithrombins, Drug Therapy, Combination, Electrocardiography, Fibrinolytic Agents, Heparin, Hirudins, Humans, Myocardial Infarction, Peptide Fragments, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex, Preoperative Care, Randomized Controlled Trials as Topic, Recombinant Proteins, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

This study sought to investigate the relative safety and efficacy of bivalirudin versus heparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI) and in those with ST-segment elevation myocardial infarction (STEMI). The safety of bivalirudin in PCI, particularly in patients with STEMI, continues to be debated. We searched the on-line databases for randomized controlled trials of bivalirudin versus heparin plus GP IIb/IIIa inhibitors. Data on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes at 30 days were extracted. A total of 19,856 PCI patients included in 7 randomized trials and 5,820 patients with STEMI included in 2 randomized trials were separately analyzed. At 30 days, bivalirudin use in patients undergoing PCI resulted in similar rates of death, myocardial infarction, repeat revascularization, and stent thrombosis. In patients with STEMI, bivalirudin use resulted in decreased cardiac mortality (risk ratio [RR] 0.70, 95% confidence interval [CI] 0.50 to 0.97, p=0.03) compared with heparin plus GP IIb/IIIa inhibitors but an increase in definite stent thrombosis at 30 days (RR 1.88, 95% CI 1.09 to 3.24, p=0.02) driven by an increase in acute stent thrombosis (RR 5.48, 95% CI 2.30 to 13.07, p=0.0001). Bivalirudin use was associated with a decrease in Thrombolysis In Myocardial Infarction (TIMI) major (RR 0.58, 95% CI 0.46 to 0.74, p

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