PMID- 30269393
OWN - NLM
STAT- MEDLINE
DCOM- 20200210
LR  - 20200210
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 93
IP  - 2
DP  - 2019 Feb 1
TI  - Safety and efficacy of switching from unfractionated heparin to bivalirudin 
      during primary percutaneous coronary intervention.
PG  - 241-247
LID - 10.1002/ccd.27828 [doi]
AB  - OBJECTIVES: To evaluate the safety and efficacy of switching to bivalirudin 
      during primary percutaneous coronary intervention (PCI) for patients who received 
      preprocedure unfractionated heparin (UFH). BACKGROUND: Current guidelines favor 
      bivalirudin for primary PCI in patients at high risk of bleeding, particularly 
      when femoral access is used. However, patients with ST-segment elevation 
      myocardial infarction frequently receive UFH before arrival in the 
      catheterization laboratory. METHODS: Scientific databases and websites were 
      searched for randomized controlled trials. Patients were divided into those who 
      received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin 
      group); those switched to bivalirudin during primary PCI from preprocedure UFH 
      (switch group); and those who received bivalirudin without preprocedure UFH 
      (Biv-alone group). Both traditional pairwise meta-analyses using moderator 
      analyses and network meta-analyses using mixed-treatment comparison models were 
      performed. RESULTS: Data from five trials including13,547 patients were analyzed. 
      In mixed-comparison models, switching to bivalirudin during primary PCI was 
      associated with lower rates for all-cause mortality and major adverse 
      cardiovascular events (MACEs) compared to the other strategies. Rates for 
      all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar 
      for the heparin and Biv-alone groups. Switching strategies was also associated 
      with lower major bleeding rates compared to heparin alone. Similarly, in a 
      standard pairwise model, both the switch and Biv-alone groups were associated 
      with decreased bleeding risk compared to the heparin group. However, only the 
      switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95% 
      CI, 0.30-0.75; P = 0.001), MACE (RR, 0.67; 95% CI, 0.49-0.91; P = 0.012), and 
      NACE (RR, 0.61; 95% CI, 0.41-0.92; P = 0.019) compared with heparin alone. 
      CONCLUSIONS: During primary PCI, use of bivalirudin for those receiving 
      preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, 
      and all-cause mortality compared to heparin +/- GPI. This strategy was also 
      associated with decreased rates for MACEs and all-cause mortality compared to 
      bivalirudin alone without preprocedure UFH.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Shah, Rahman
AU  - Shah R
AUID- ORCID: 0000-0002-5048-538X
AD  - Department of Medicine, University of Tennessee, Memphis, Tennessee.
FAU - Jovin, Ion S
AU  - Jovin IS
AD  - Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
FAU - Chaudhry, Amina
AU  - Chaudhry A
AD  - Department of Medicine, University of Tennessee, Memphis, Tennessee.
FAU - Haji, Showkat A
AU  - Haji SA
AD  - Department of Medicine, University of Tennessee, Memphis, Tennessee.
FAU - Askari, Raza
AU  - Askari R
AD  - Department of Medicine, University of Tennessee, Memphis, Tennessee.
FAU - Dennis, Mallie M
AU  - Dennis MM
AD  - Department of Medicine, University of Tennessee, Memphis, Tennessee.
FAU - Berzingi, Chalak
AU  - Berzingi C
AD  - Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia.
AD  - Division of Cardiology, West Virginia University, Morgantown, West Virginia.
FAU - Rao, Sunil V
AU  - Rao SV
AD  - Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20180930
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
CIN - Catheter Cardiovasc Interv. 2019 Feb 1;93(2):248-249. PMID: 30719862
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Antithrombins/*administration & dosage/adverse effects
MH  - *Drug Substitution
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hirudins/*administration & dosage/adverse effects
MH  - Humans
MH  - Network Meta-Analysis
MH  - Peptide Fragments/*administration & dosage/adverse effects
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Recombinant Proteins/administration & dosage/adverse effects
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - bivalirudin
OT  - heparin
OT  - percutaneous coronary intervention
OT  - switch
EDAT- 2018/10/01 06:00
MHDA- 2020/02/11 06:00
CRDT- 2018/10/01 06:00
PHST- 2018/03/14 00:00 [received]
PHST- 2018/06/12 00:00 [revised]
PHST- 2018/07/14 00:00 [accepted]
PHST- 2018/10/01 06:00 [pubmed]
PHST- 2020/02/11 06:00 [medline]
PHST- 2018/10/01 06:00 [entrez]
AID - 10.1002/ccd.27828 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2019 Feb 1;93(2):241-247. doi: 10.1002/ccd.27828. 
      Epub 2018 Sep 30.