PMID- 26448869
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20151009
LR  - 20210112
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 2
IP  - 1
DP  - 2015
TI  - Bivalirudin versus unfractionated heparin: a meta-analysis of patients receiving 
      percutaneous coronary intervention for acute coronary syndromes.
PG  - e000258
LID - 10.1136/openhrt-2015-000258 [doi]
LID - e000258
AB  - OBJECTIVE: Acute coronary syndrome (ACS) encompasses ST segment elevation 
      myocardial infarction (STEMI), with generally high thrombus burden and non-ST 
      segment elevation ACS (NSTE-ACS), with lower thrombus burden. In the setting of 
      percutaneous coronary intervention (PCI) for ACS, bivalirudin appears superior to 
      unfractionated heparin (UFH), driven by reduced major bleeding. Recent trials 
      suggest that the benefit of bivalirudin may be reduced with use of transradial 
      access and evolution in antiplatelet therapy. Moreover, a differential role of 
      bivalirudin in ACS cohorts is unknown. METHODS: A meta-analysis of randomised 
      trials comparing bivalirudin and UFH in patients with ACS receiving PCI, with 
      separate analyses in STEMI and NSTE-ACS groups. Overall estimates of treatment 
      effect were calculated with random-effects model. RESULTS: In 5 trials of STEMI 
      (10 358 patients), bivalirudin increased the risk of acute stent thrombosis (ST) 
      (OR 3.62; CI 1.95 to 6.74; p<0.0001) compared with UFH. Bivalirudin reduced the 
      risk of major bleeding only when compared with UFH plus planned glycoprotein 
      IIb/IIIa inhibitors (GPI) (OR 0.49; CI 0.36 to 0.67; p<0.00001). In 14 NSTE-ACS 
      trials (25 238 patients), there was no difference between bivalirudin and UFH in 
      death, myocardial infarction or ST. However, bivalirudin reduced the risk of 
      major bleeding compared with UFH plus planned GPI (OR 0.52; CI 0.43 to 0.62; 
      p<0.00001), or UFH plus provisional GPI (OR 0.68; CI 0.46 to 1.01; p=0.05). The 
      reduction in major bleeding with bivalirudin was not related to vascular access 
      site. CONCLUSIONS: Bivalirudin increases the risk of acute ST in STEMI, but may 
      confer an advantage over UFH in NSTE-ACS while undergoing PCI, reducing major 
      bleeding without an increase in ST.
FAU - Farag, Mohamed
AU  - Farag M
AD  - Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire 
      , UK ; Postgraduate Medical School, University of Hertfordshire , Hertfordshire , 
      UK.
FAU - Gorog, Diana A
AU  - Gorog DA
AD  - Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire 
      , UK ; Postgraduate Medical School, University of Hertfordshire , Hertfordshire , 
      UK ; National Heart & Lung Institute, Imperial College , London , UK.
FAU - Prasad, Abhiram
AU  - Prasad A
AD  - Cardiovascular and Cell Sciences Research Institute, St George's, University of 
      London , London , UK.
FAU - Srinivasan, Manivannan
AU  - Srinivasan M
AD  - Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire 
      , UK.
LA  - eng
PT  - Journal Article
DEP - 20151001
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
PMC - PMC4593234
EDAT- 2015/10/09 06:00
MHDA- 2015/10/09 06:01
PMCR- 2015/10/01
CRDT- 2015/10/09 06:00
PHST- 2015/04/03 00:00 [received]
PHST- 2015/08/07 00:00 [revised]
PHST- 2015/08/27 00:00 [accepted]
PHST- 2015/10/09 06:00 [entrez]
PHST- 2015/10/09 06:00 [pubmed]
PHST- 2015/10/09 06:01 [medline]
PHST- 2015/10/01 00:00 [pmc-release]
AID - openhrt-2015-000258 [pii]
AID - 10.1136/openhrt-2015-000258 [doi]
PST - epublish
SO  - Open Heart. 2015 Oct 1;2(1):e000258. doi: 10.1136/openhrt-2015-000258. 
      eCollection 2015.