PMID- 26177601
OWN - NLM
STAT- MEDLINE
DCOM- 20160829
LR  - 20220129
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 114
IP  - 5
DP  - 2015 Nov
TI  - Comparative efficacy and safety of anticoagulant strategies for acute coronary 
      syndromes. Comprehensive network meta-analysis of 42 randomised trials involving 
      117,353 patients.
PG  - 933-44
LID - 10.1160/TH14-12-1066 [doi]
AB  - International guidelines differ in strengths of recommendation for 
      anticoagulation strategies in acute coronary syndromes (ACS). We performed a 
      comprehensive network meta-analysis (NMA) of randomised controlled trials (RCTs) 
      to investigate the comparative efficacy and safety of parenteral anticoagulants 
      in ACS. MEDLINE, Cochrane, EMBASE, Google Scholar, major cardiology websites, and 
      abstracts/presentations were searched. Six treatments were identified: 1) 
      unfractionated heparin (UFH) + glycoprotein IIb/IIIa inhibitor (GPI) [UFH+GPI], 
      2) UFH+/-GPI, 3) bivalirudin, 4) low-molecular-weight heparins (LMWHs), 5) 
      otamixaban, and 6) fondaparinux. Prespecified outcomes (death, myocardial 
      infarction [MI], revascularisation, major bleeding [MB], minor bleeding, and 
      stent thrombosis [ST]) were evaluated up to 30 days. Forty-two RCTs involving 
      117,353 patients were included. No significant differences in mortality rates 
      were found among strategies. Compared to UFH+GPI, bivalirudin reduced the odds of 
      MB but increased the odds of ST and MI. LMWHs vs bivalirudin reduced MI risk at 
      the price of MB excess. UFH+/-GPI significantly increased the odds of MI vs LMWHs, 
      of ST vs UFH+GPI, and of MB vs bivalirudin. Reduced ST risk with otamixaban vs 
      UFH+/-GPI and vs bivalirudin was offset by a marked 2.5- to four-fold MB excess. 
      Fondaparinux showed an intermediate profile. Results for ST-segment elevation MI 
      were consistent with the overall findings. Early anticoagulant strategies for ACS 
      differ in efficacy and safety, with UFH+GPI and LMWHs reducing ischaemic but 
      increasing bleeding risk, and bivalirudin reducing MB but increases MI and ST. 
      The findings support individualised therapy based on patients' bleeding and 
      ischaemic risks.
FAU - Navarese, Eliano Pio
AU  - Navarese EP
AD  - Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular 
      Medicine, Heinrich-Heine-University, Dusseldorf, Germany, E-mail: 
      elianonavarese@gmail.com.
FAU - Andreotti, Felicita
AU  - Andreotti F
FAU - Kolodziejczak, Michalina
AU  - Kolodziejczak M
FAU - Schulze, Volker
AU  - Schulze V
FAU - Wolff, Georg
AU  - Wolff G
FAU - Dias, Sofia
AU  - Dias S
FAU - Claessen, Bimmer
AU  - Claessen B
FAU - Brouwer, Marc
AU  - Brouwer M
FAU - Tarantini, Giuseppe
AU  - Tarantini G
FAU - Iliceto, Sabino
AU  - Iliceto S
FAU - Brockmeyer, Maximilian
AU  - Brockmeyer M
FAU - Kowalewski, Mariusz
AU  - Kowalewski M
FAU - Lin, Yingfeng
AU  - Lin Y
FAU - Eikelboom, John
AU  - Eikelboom J
FAU - Musumeci, Giuseppe
AU  - Musumeci G
FAU - Lee, Leong
AU  - Lee L
FAU - Lip, Gregory Y H
AU  - Lip GY
FAU - Valgimigli, Marco
AU  - Valgimigli M
FAU - Berti, Sergio
AU  - Berti S
FAU - Kelm, Malte
AU  - Kelm M
LA  - eng
GR  - MR/M005232/1/MRC_/Medical Research Council/United Kingdom
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20150716
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
SB  - IM
CIN - Thromb Haemost. 2015 Nov;114(5):872-4. PMID: 26271308
MH  - Acute Coronary Syndrome/complications/*drug therapy
MH  - Anticoagulants/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Hemorrhage/etiology/*prevention & control
MH  - Humans
MH  - Myocardial Infarction/etiology/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Survival Analysis
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - network meta-analysis
OT  - parenteral anticoagulant
EDAT- 2015/07/17 06:00
MHDA- 2016/08/30 06:00
CRDT- 2015/07/17 06:00
PHST- 2014/12/20 00:00 [received]
PHST- 2015/05/19 00:00 [accepted]
PHST- 2015/07/17 06:00 [entrez]
PHST- 2015/07/17 06:00 [pubmed]
PHST- 2016/08/30 06:00 [medline]
AID - 14-12-1066 [pii]
AID - 10.1160/TH14-12-1066 [doi]
PST - ppublish
SO  - Thromb Haemost. 2015 Nov;114(5):933-44. doi: 10.1160/TH14-12-1066. Epub 2015 Jul 
      16.