PMID- 24576526
OWN - NLM
STAT- MEDLINE
DCOM- 20140415
LR  - 20161125
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 167
IP  - 3
DP  - 2014 Mar
TI  - Impact of baseline hemorrhagic risk on the benefit of bivalirudin versus 
      unfractionated heparin in patients treated with coronary angioplasty: a 
      meta-regression analysis of randomized trials.
PG  - 401-412.e6
LID - S0002-8703(13)00835-1 [pii]
LID - 10.1016/j.ahj.2013.11.013 [doi]
AB  - BACKGROUND: Bivalirudin significantly reduces 30-day major and minor bleeding 
      compared with unfractionated heparin (UFH), while resulting in similar or lower 
      rates of ischemic events in both patients with stable and unstable coronary 
      disease undergoing percutaneous coronary intervention. We performed a 
      meta-analysis of randomized trials to evaluate the impact of bivalirudin compared 
      with UFH, with or without glycoprotein IIb/IIIa receptor inhibitors (GPI), on the 
      rates of mortality, myocardial infarction (MI), and major bleeding. METHODS: We 
      searched electronic databases for randomized controlled trials with >100 patients 
      comparing bivalirudin (+/-provisional GPI) with UFH with either routine or 
      provisional GPI in patients undergoing percutaneous coronary intervention. The 
      principal efficacy end points were mortality and MI within 30 day, whereas major 
      bleeding was the principal safety end point. We assessed the benefit of 
      bivalirudin for each efficacy end point relative to the baseline bleeding risk, 
      using the control (UFH) major bleeding rate as proxy for that risk. RESULTS: A 
      total of 12 randomized trials that enrolled 33,261 patients were included. 
      Overall, there was no significant difference in mortality and MI between 
      bivalirudin monotherapy and UFH (+/-GPI), whereas major bleeding was significantly 
      lower with bivalirudin. Bivalirudin reduced major and minor bleeding across the 
      entire bleeding risk spectrum. CONCLUSIONS: Bivalirudin significantly reduces 
      major and minor bleeding regardless of the estimated baseline hemorrhagic risk.
CI  - (c) 2014.
FAU - Tarantini, Giuseppe
AU  - Tarantini G
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua 
      Medical School, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
FAU - Brener, Sorin Jakob
AU  - Brener SJ
AD  - Weil Cornell Medical College, NY Methodist Hospital, Brooklyn, NY.
FAU - Barioli, Alberto
AU  - Barioli A
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua 
      Medical School, Padua, Italy.
FAU - Gratta, Andrea
AU  - Gratta A
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua 
      Medical School, Padua, Italy.
FAU - Parodi, Guido
AU  - Parodi G
AD  - Department of Cardiology, Careggi Hospital, Florence, Italy.
FAU - Rossini, Roberta
AU  - Rossini R
AD  - Department of Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
FAU - Navarese, Eliano Pio
AU  - Navarese EP
AD  - Department of Cardiology, Radboud University Medical Center, Nijmegen, The 
      Netherlands.
FAU - Niccoli, Giampaolo
AU  - Niccoli G
AD  - Department of Cardiovascular Medicine, Policlinico A. Gemelli, Catholic 
      University of the Sacred Heart, Rome, Italy.
FAU - Frigo, Anna Chiara
AU  - Frigo AC
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua 
      Medical School, Padua, Italy.
FAU - Musumeci, Giuseppe
AU  - Musumeci G
AD  - Department of Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
FAU - Iliceto, Sabino
AU  - Iliceto S
AD  - Department of Cardiac, Thoracic and Vascular Sciences, University of Padua 
      Medical School, Padua, Italy.
FAU - Stone, Gregg Whitney
AU  - Stone GW
AD  - Columbia University Medical Center and the Cardiovascular Research Foundation, 
      New York, NY.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20131219
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anticoagulants)
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  - Anticoagulants/*therapeutic use
MH  - Antithrombins/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Myocardial Ischemia/*prevention & control
MH  - Peptide Fragments/*therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/therapeutic use
MH  - Regression Analysis
MH  - Treatment Outcome
EDAT- 2014/03/01 06:00
MHDA- 2014/04/16 06:00
CRDT- 2014/03/01 06:00
PHST- 2013/08/24 00:00 [received]
PHST- 2013/11/24 00:00 [accepted]
PHST- 2014/03/01 06:00 [entrez]
PHST- 2014/03/01 06:00 [pubmed]
PHST- 2014/04/16 06:00 [medline]
AID - S0002-8703(13)00835-1 [pii]
AID - 10.1016/j.ahj.2013.11.013 [doi]
PST - ppublish
SO  - Am Heart J. 2014 Mar;167(3):401-412.e6. doi: 10.1016/j.ahj.2013.11.013. Epub 2013 
      Dec 19.