PMID- 27526953
OWN - NLM
STAT- MEDLINE
DCOM- 20170615
LR  - 20170615
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 89
IP  - 4
DP  - 2017 Mar 1
TI  - Hemorrhagic and ischemic outcomes of Heparin vs. Bivalirudin in carotid artery 
      stenting: A meta-analysis of studies.
PG  - 746-753
LID - 10.1002/ccd.26685 [doi]
AB  - INTRODUCTION: Bivalirudin, has been shown to have comparable efficacy and better 
      safety profile when compared to unfractionated heparin (UFH) in percutaneous 
      coronary interventions. Bivalirudin's safety in carotid artery stenting (CAS) was 
      associated with better outcomes than heparin in some studies. In this Meta 
      analysis we examine the hemorrhagic and ischemic outcomes associated with 
      Bivalirudin compared to UFH during CAS. METHODS: A comprehensive literature 
      search was conducted with the electronic databases MEDLINE, EMBASE, and CENTRAL. 
      Random-effects meta-analysis method was used to pool risk ratio (RR) for both 
      Heparin and Bivalirudin with 95% confidence interval (CI). Study outcomes 
      included hemorrhagic complications; major/minor bleeding and intracranial 
      hemorrhage (ICH) as well as ischemic complications including ischemic stroke, 
      myocardial infarction, and 30 day mortality. RESULTS: A total of four studies 
      were included enrolling 7,784 patients. Compared to UFH, Bivalirudin was 
      associated with significantly lower major bleeding events with a relative risk 
      (RR) of 0.53 (95% CI: 0.35-0.80; I(2)  = 0%). Minor bleeding events were 
      significantly lower in the Bivalirudin group with a RR of 0.41 (95% CI: 0.2-0.82; 
      I(2)  = 0%). Looking into other outcomes, there were no significant differences 
      between anticoagulation strategies in terms of ischemic stroke (RR 0.8, with 95% 
      CI: 0.60-1.06), intracranial hemorrhage (RR 0.73 with 95% CI: 0.27-1.98), 
      myocardial infarction (RR 1.01 with 95% CI: 0.59-1.73) or 30 day mortality (RR 
      0.83 with 95% CI: 0.47-1.47). CONCLUSION: Compared to UFH, Bivalirudin is 
      associated with lower bleeding risk when used during CAS. (c) 2016 Wiley 
      Periodicals, Inc.
CI  - (c) 2016 Wiley Periodicals, Inc.
FAU - Omran, Jad
AU  - Omran J
AD  - Cardiovascular Medicine Department at the University of Missouri-Columbia School 
      of Medicine, Columbia, Missouri.
FAU - Abdullah, Obai
AU  - Abdullah O
AD  - Internal Medicine Department, University of Florida Collage of Medicine, 
      Gainesville, Florida.
FAU - Abu-Fadel, Mazen
AU  - Abu-Fadel M
AD  - Internal Medicine Department, Section of Cardiovascular Disease, University of 
      Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
FAU - Gray, William A
AU  - Gray WA
AD  - Department of Cardiology, Columbia University Medical Center, New York, New York.
FAU - Firwana, Belal
AU  - Firwana B
AD  - Department of Hematology and Oncology, University of Arkansas for Medical 
      Sciences, Little Rock, Arkansas.
FAU - Drachman, Douglas E
AU  - Drachman DE
AD  - Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
FAU - Mahmud, Ehtisham
AU  - Mahmud E
AD  - Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University 
      of California-San Diego, La Jolla, California.
FAU - Aronow, Herebert D
AU  - Aronow HD
AD  - Department of Cardiology, Lifespan Cardiovascular Institue, Providence, Rhode 
      Island.
FAU - White, Christopher J
AU  - White CJ
AD  - Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
FAU - Al-Dadah, Ashraf S
AU  - Al-Dadah AS
AD  - Prairie Heart Institute, Springfield, IL.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20160816
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
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/pharmacology
MH  - Brain Ischemia/*epidemiology/etiology/prevention & control
MH  - Carotid Stenosis/complications/*surgery
MH  - Fibrinolytic Agents/pharmacology
MH  - Global Health
MH  - Heparin/*pharmacology
MH  - Hirudins/*pharmacology
MH  - Humans
MH  - Incidence
MH  - Peptide Fragments/*pharmacology
MH  - Postoperative Hemorrhage/*epidemiology/etiology/prevention & control
MH  - Recombinant Proteins/pharmacology
MH  - *Stents
OTO - NOTNLM
OT  - bivalirudin
OT  - carotid artery stenting
OT  - heparin
OT  - major bleeding
OT  - minor bleeding
EDAT- 2016/08/17 06:00
MHDA- 2017/06/16 06:00
CRDT- 2016/08/17 06:00
PHST- 2016/02/05 00:00 [received]
PHST- 2016/05/16 00:00 [revised]
PHST- 2016/07/02 00:00 [accepted]
PHST- 2016/08/17 06:00 [pubmed]
PHST- 2017/06/16 06:00 [medline]
PHST- 2016/08/17 06:00 [entrez]
AID - 10.1002/ccd.26685 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2017 Mar 1;89(4):746-753. doi: 10.1002/ccd.26685. 
      Epub 2016 Aug 16.