PMID- 26899489
OWN - NLM
STAT- MEDLINE
DCOM- 20160809
LR  - 20161126
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 117
IP  - 8
DP  - 2016 Apr 15
TI  - Meta-Analysis of Effects of Bivalirudin Versus Heparin on Myocardial Ischemic and 
      Bleeding Outcomes After Percutaneous Coronary Intervention.
PG  - 1256-66
LID - S0002-9149(16)30137-0 [pii]
LID - 10.1016/j.amjcard.2016.01.015 [doi]
AB  - Bivalirudin is an alternative to unfractionated heparin (UFH) anticoagulation 
      during percutaneous coronary intervention. Previously, we have reported clinical 
      benefit on major bleeding in favor of bivalirudin compared with UFH monotherapy 
      but inconclusive results on mortality. Controversial data have been reported in 
      the last 2 years. We conducted an updated meta-analysis including randomized 
      trials and observational studies, which evaluated ischemic and bleeding outcomes 
      for bivalirudin compared with UFH-only during percutaneous coronary intervention. 
      We included 18 observational studies and 12 randomized trials published from 2003 
      to 2015. Primary outcomes were major adverse cardiovascular events within 30 days 
      including death, myocardial infarction, and urgent revascularization and stent 
      thrombosis, major bleeding, and transfusion. Overall, we found a significant risk 
      reduction with bivalirudin for major bleeding (odds ratio [OR] 0.59, 95% 
      confidence interval [CI] 0.49 to 0.71, p <0.0001) and for transfusion (OR 0.79, 
      95% CI 0.66 to 0.95, p = 0.01) and similar risk for major adverse cardiovascular 
      events (OR 0.98, 95% CI 0.86 to 1.12, p = 0.80). However, there was a substantial 
      increased risk of stent thrombosis associated with bivalirudin (OR 1.52, 95% CI 
      1.11 to 2.08, p = 0.009). No impact on mortality was found. Meta-regression 
      analyses on major bleeding suggested that bivalirudin was more effective than UFH 
      at doses >60 IU/kg and independent of radial access. In conclusion, compared with 
      UFH monotherapy, bivalirudin remains associated with less bleeding risk but 
      higher stent thrombosis risk. Further study remains required to define its role 
      in current antithrombotic armamentarium.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Barria Perez, Alberto E
AU  - Barria Perez AE
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada.
FAU - Rao, Sunil V
AU  - Rao SV
AD  - Duke Clinical Research Institute, Durham, North Carolina.
FAU - Jolly, Sanjit J
AU  - Jolly SJ
AD  - McMaster University and Population Health Research Institute, Hamilton Health 
      Sciences, Hamilton, Ontario, Canada.
FAU - Pancholy, Samir B
AU  - Pancholy SB
AD  - The Wright Center for Graduate Medical Education, The Common Wealth Medical 
      College, Scranton, Pennsylvania.
FAU - Plourde, Guillaume
AU  - Plourde G
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada.
FAU - Rimac, Goran
AU  - Rimac G
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada.
FAU - Poirier, Yann
AU  - Poirier Y
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada.
FAU - Costerousse, Olivier
AU  - Costerousse O
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada.
FAU - Bertrand, Olivier F
AU  - Bertrand OF
AD  - Quebec Heart-Lung Institute, Quebec, Quebec, Canada. Electronic address: 
      olivier.bertrand@criucpq.ulaval.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20160128
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Antithrombins)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Antithrombins/adverse effects/therapeutic use
MH  - Fibrinolytic Agents/adverse effects/therapeutic use
MH  - Global Health
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Incidence
MH  - Myocardial Ischemia/*therapy
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - *Percutaneous Coronary Intervention
MH  - Postoperative Hemorrhage/chemically induced/*epidemiology
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Thrombosis/*prevention & control
EDAT- 2016/02/24 06:00
MHDA- 2016/08/10 06:00
CRDT- 2016/02/23 06:00
PHST- 2015/11/30 00:00 [received]
PHST- 2016/01/22 00:00 [revised]
PHST- 2016/01/22 00:00 [accepted]
PHST- 2016/02/23 06:00 [entrez]
PHST- 2016/02/24 06:00 [pubmed]
PHST- 2016/08/10 06:00 [medline]
AID - S0002-9149(16)30137-0 [pii]
AID - 10.1016/j.amjcard.2016.01.015 [doi]
PST - ppublish
SO  - Am J Cardiol. 2016 Apr 15;117(8):1256-66. doi: 10.1016/j.amjcard.2016.01.015. 
      Epub 2016 Jan 28.