PMID- 22591669
OWN - NLM
STAT- MEDLINE
DCOM- 20121204
LR  - 20181201
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 110
IP  - 4
DP  - 2012 Aug 15
TI  - Meta-analysis comparing bivalirudin versus heparin monotherapy on ischemic and 
      bleeding outcomes after percutaneous coronary intervention.
PG  - 599-606
LID - 10.1016/j.amjcard.2012.03.051 [doi]
AB  - With femoral access, bivalirudin decreases risks of major bleeding after 
      percutaneous coronary intervention (PCI) and provides better net clinical benefit 
      compared to unfractionated heparin (UFH) plus planned glycoprotein IIb/IIIa 
      inhibitors. Whether this benefit exists compared to UFH monotherapy is less 
      clear. We performed a systematic review and meta-analysis to compare outcomes in 
      patients undergoing transfemoral PCI with UFH or bivalirudin. Randomized trials 
      (n = 3) and observational studies (n = 13) comparing bivalirudin to UFH 
      monotherapy were reviewed. Primary outcomes were 30-day rates of major adverse 
      cardiovascular events (MACEs) including death, myocardial infarction (MI), urgent 
      revascularization, as well as all-cause mortality, MI, major bleeding, and blood 
      transfusion. We collected data from 16 studies involving 32,492 patients 
      undergoing PCI. Most observational studies were performed in the United States, 
      whereas all randomized trials were done in Europe. Compared to UFH monotherapy, 
      bivalirudin was associated with similar risk of MACEs (odds ratios [OR] 0.92, 95% 
      confidence interval [CI] 0.75 to 1.12), a substantial 45% relative decrease in 
      major bleeding (OR 0.55, 95% CI 0.43 to 0.72), and a trend in the decrease of 
      transfusion (OR 0.87, 95% CI 0.70 to 1.08). A decrease in mortality was seen in 
      observational studies (OR 0.62, 95% CI 0.45 to 0.85) but remained inconclusive in 
      randomized trials (OR 0.63, 95% CI 0.20 to 2.01). MI rate was similar with the 2 
      anticoagulants. In conclusion, in patients undergoing transfemoral PCI, the 
      benefit of bivalirudin over UFH monotherapy is driven by a significant decrease 
      in major bleeding with similar rates of MACE. As PCI practice moves toward other 
      bleeding-avoidance strategies such as the radial approach, future studies should 
      focus on the interaction between anticoagulant strategy and access-site choice.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - Bertrand, Olivier F
AU  - Bertrand OF
AD  - Quebec Heart-Lung Institute, Quebec City, Quebec, Canada. 
      olivier.bertrand@criucpq.ulaval.ca
FAU - Jolly, Sanjit S
AU  - Jolly SS
FAU - Rao, Sunil V
AU  - Rao SV
FAU - Patel, Tejas
AU  - Patel T
FAU - Belle, Loic
AU  - Belle L
FAU - Bernat, Ivo
AU  - Bernat I
FAU - Parodi, Guido
AU  - Parodi G
FAU - Costerousse, Olivier
AU  - Costerousse O
FAU - Mann, Tift
AU  - Mann T
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20120515
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - *Angioplasty, Balloon, Coronary
MH  - Antithrombins/*administration & dosage
MH  - Cardiovascular Diseases/epidemiology/mortality
MH  - Heparin/*administration & dosage
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Myocardial Ischemia/*prevention & control
MH  - Peptide Fragments/*administration & dosage
MH  - Postoperative Complications
MH  - Postoperative Hemorrhage/*prevention & control
MH  - Recombinant Proteins/administration & dosage
MH  - Treatment Outcome
EDAT- 2012/05/18 06:00
MHDA- 2012/12/10 06:00
CRDT- 2012/05/18 06:00
PHST- 2012/03/03 00:00 [received]
PHST- 2012/03/27 00:00 [revised]
PHST- 2012/03/27 00:00 [accepted]
PHST- 2012/05/18 06:00 [entrez]
PHST- 2012/05/18 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
AID - S0002-9149(12)01195-2 [pii]
AID - 10.1016/j.amjcard.2012.03.051 [doi]
PST - ppublish
SO  - Am J Cardiol. 2012 Aug 15;110(4):599-606. doi: 10.1016/j.amjcard.2012.03.051. 
      Epub 2012 May 15.