PMID- 19718462
OWN - NLM
STAT- MEDLINE
DCOM- 20091125
LR  - 20161125
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 102
IP  - 3
DP  - 2009 Sep
TI  - Bivalirudin as compared to unfractionated heparin among patients undergoing 
      coronary angioplasty: A meta-analyis of randomised trials.
PG  - 428-36
LID - 10.1160/TH09-05-0287 [doi]
AB  - It has been shown that bleeding complications are associated with higher 
      mortality rates among patients undergoing coronary angioplasty. Due to its 
      properties, bivalirudin may provide benefits in terms of bleeding and thrombotic 
      complications as compared to unfractionated heparin (UFH). The aim of the current 
      study was to perform a meta-analysis of randomised trials to evaluate whether 
      bivalirudin might offer benefits in terms of mortality as compared to UFH. We 
      obtained results from all randomised trials evaluating the benefits of adjunctive 
      bivalirudin as compared to UFH with or without Gp IIb-IIIa inhibitors among 
      patients undergoing coronary angioplasty. The literature was scanned by formal 
      searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to 
      October 2008. The following keywords were used: randomised trial, coronary 
      angioplasty, stent, reperfusion, primary angioplasty, bivalirudin, direct 
      thrombin inhibitors, hirulog. Primary endpoint was mortality. Secondary endpoint 
      was infarction. Safety endpoint was the risk of major bleeding complications. No 
      language restriction was applied. A total of nine randomised trials were included 
      in the meta-analysis, with 15655 patients randomised to bivalirudin and 13104 
      patients randomised to UFH. We did not observe any difference in mortality 
      between bivalirudin and UFH (1.73% vs 1.67%, p = 0.15) without any relationship 
      between the baseline risk of mortality (r = 0.17, p = 0.71) or the reduction in 
      major bleeding complications (r = -0.29, p = 0.53) and the benefits in mortality 
      with bivalirudin. A trend in higher risk of myocardial infarction was observed 
      with bivalirudin (6.9% vs 5.9%, p = 0.07, p het = 0.65). Bivalirudin was 
      associated with a significant reduction in major bleeding complications (1.7% vs 
      3.4%, p < 0.0001), as compared to UFH. This meta-analysis shows that among 
      patients undergoing coronary angioplasty, bivalirudin is associated with 
      significant reduction in major bleeding complications. However, these benefits 
      did not translate into benefits in mortality, with even a trend in higher risk of 
      myocardial infarction.
FAU - De Luca, Giuseppe
AU  - De Luca G
AD  - Chief Interventional Cardiology, Maggiore della Carita Hospital, Eastern Piedmont 
      University A. Avogadro, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
FAU - Cassetti, Ettore
AU  - Cassetti E
FAU - Verdoia, Monica
AU  - Verdoia M
FAU - Marino, Paolo
AU  - Marino P
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Angioplasty/*methods
MH  - Anticoagulants/therapeutic use
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Middle Aged
MH  - Myocardial Reperfusion
MH  - Peptide Fragments/*therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/chemistry
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/therapeutic use
MH  - Regression Analysis
MH  - Stents
MH  - Treatment Outcome
RF  - 39
EDAT- 2009/09/01 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/09/01 09:00
PHST- 2009/09/01 09:00 [entrez]
PHST- 2009/09/01 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - 09-05-0287 [pii]
AID - 10.1160/TH09-05-0287 [doi]
PST - ppublish
SO  - Thromb Haemost. 2009 Sep;102(3):428-36. doi: 10.1160/TH09-05-0287.