PMID- 27862911
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20180507
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 90
IP  - 2
DP  - 2017 Aug 1
TI  - Effect of post-primary percutaneous coronary intervention bivalirudin infusion on 
      net adverse clinical events and mortality: A comprehensive pairwise and network 
      meta-analysis of randomized controlled trials.
PG  - 196-204
LID - 10.1002/ccd.26859 [doi]
AB  - OBJECTIVE: To compare the efficacies of various post-percutaneous coronary 
      intervenetion (PCI) bivalirudin doses on net adverse clinical events (NACEs) and 
      mortality. BACKGROUND: In primary PCI, lower risk of bleeding with bivalirudin 
      (vs. unfractionated heparin [UFH]) is counterbalanced by an increased risk of 
      acute stent thrombosis (ST). Several randomized clinical trials (RCTs) and a 
      recent meta-analysis suggest that acute ST risk may be eliminated without 
      compromising the bleeding benefit, but only if the full dose, not a low dose, of 
      bivalirudin is continued post-PCI. However, it is not known whether this improved 
      risk leads to lower rates of NACEs and mortality. METHODS: Scientific databases 
      and Web sites were searched for RCTs. Trials were included if study patients were 
      undergoing primary PCI for acute ST-segment elevation myocardial infarction and 
      were randomly assigned to bivalirudin or UFH treatment. The bivalirudin arm was 
      divided based on post-PCI bivalirudin dosage: The Biv-Full group received 1.75 
      mg/kg/h, the Biv-Low group, 0.25 mg/kg/h, and the Biv-No group, none. RESULTS: 
      Six RCTs involving 16,842 patients were found. In pairwise meta-analysis, 
      bivalirudin improved 30-day all-cause mortality by 35% and cardiac mortality by 
      32%, but did not yield a NACE rate better than that achieved with UFH. Subgroup 
      analysis showed the Biv-Full group had a 46% lower NACE rate and 47% lower 
      all-cause mortality than UFH. These effects were not seen in the other two 
      groups. Network meta-analysis yielded similar results. At treatment ranking, the 
      Biv-Full group yielded the best treatment efficacy. CONCLUSIONS: In primary PCI, 
      full-dose bivalirudin infusion for 3-4 hr after PCI appeared to improve NACE 
      rates compared to UFH. It also seemed to be the most effective strategy for 
      improving cardiac mortality and all-cause mortality. (c) 2016 Wiley Periodicals, 
      Inc.
CI  - (c) 2016 Wiley Periodicals, Inc.
FAU - Shah, Rahman
AU  - Shah R
AD  - School of Medicine, Section of Cardiology, University of Tennessee, Memphis, TN.
AD  - Veterans Affairs Medical Center, Memphis, TN.
FAU - Matin, Khalid
AU  - Matin K
AD  - Section of Hematology, Virginia Commonwealth University, Richmond, VA.
FAU - Rogers, Kelly C
AU  - Rogers KC
AD  - College of Pharmacy, The University of Tennessee, Memphis, TN.
FAU - Rao, Sunil V
AU  - Rao SV
AD  - The Duke Clinical Research Institute, Durham, NC.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20161110
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 (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  - Anticoagulants/*administration & dosage/adverse effects
MH  - Antithrombins/*administration & dosage/adverse effects
MH  - Coronary Thrombosis/etiology/prevention & control
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hirudins/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Odds Ratio
MH  - Peptide Fragments/*administration & dosage/adverse effects
MH  - *Percutaneous Coronary Intervention/adverse effects/instrumentation/mortality
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnostic imaging/mortality/*therapy
MH  - Stents
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - bivalirudin
OT  - mortality
OT  - primary percutaneous coronary intervention
EDAT- 2016/11/20 06:00
MHDA- 2018/05/08 06:00
CRDT- 2016/11/19 06:00
PHST- 2016/08/31 00:00 [received]
PHST- 2016/10/12 00:00 [accepted]
PHST- 2016/11/20 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
PHST- 2016/11/19 06:00 [entrez]
AID - 10.1002/ccd.26859 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2017 Aug 1;90(2):196-204. doi: 10.1002/ccd.26859. 
      Epub 2016 Nov 10.