PMID- 31230646
OWN - NLM
STAT- MEDLINE
DCOM- 20200127
LR  - 20231031
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 70
IP  - 1
DP  - 2019 Jul
TI  - A systematic review and meta-analysis of bivalirudin application in peripheral 
      endovascular procedures.
PG  - 274-284.e5
LID - S0741-5214(19)30181-8 [pii]
LID - 10.1016/j.jvs.2018.12.037 [doi]
AB  - OBJECTIVE: The direct thrombin inhibitor bivalirudin (BIV) was shown to be 
      superior to unfractionated heparin (UFH) in percutaneous coronary interventions 
      for reducing procedural blood loss. The aim of this study was to compare outcome 
      profiles of BIV and UFH in peripheral endovascular procedures (PEPs) by 
      synthesizing the currently available data. METHODS: Following the PRISMA 
      statement, we conducted a comprehensive literature search using Medline, Cochrane 
      CENTRAL, PubMed, EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We 
      recruited randomized, controlled trials and well-conducted observational studies 
      that compared UFH and BIV in PEPs requiring anticoagulation, excluding 
      endovascular cardiac procedures and coronary interventions. Random-effects 
      meta-analyses were conducted to compare the outcome profiles of these two agents. 
      RESULTS: Thirteen articles containing 14 studies involving a total of 21,057 
      patients were enrolled. Of these, 2 were randomized controlled trials, 2 were 
      prospective cohort studies, and 10 were retrospective studies. There were no 
      significant differences between BIV and UFH in terms of procedural success rates, 
      major and minor perioperative bleeding, transfusion, perioperative transient 
      ischemic attack, or hemorrhagic strokes. However, compared with UFH, BIV had 
      significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58; 95% 
      confidence interval [CI], 0.40-0.86), major adverse cardiovascular events (OR, 
      0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR, 0.75; 95% CI, 
      0.63-0.88), perioperative myocardial infarction (OR, 0.73; 95% CI, 0.55-0.98), 
      major vascular complications (OR, 0.59; 95% CI, 0.39-0.91), and minor vascular 
      complications (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSIONS: Compared with UFH, PEPs 
      using BIV had comparable procedural success rates and odds of perioperative 
      transient ischemic attack and hemorrhagic stroke. However, procedures with BIV 
      had a lower but nonsignificant odds of perioperative bleeding and transfusion. 
      Depending on the procedures conducted, the patients who received BIV will have 
      reduced or comparable odds of perioperative mortality, myocardial infarction, 
      major adverse cardiovascular events, net adverse clinical events, and major and 
      minor vascular complications. Therefore, BIV may be chosen solely as an 
      alternative procedural anticoagulant to UFH for PEPs.
CI  - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Hu, Yirui
AU  - Hu Y
AD  - Biomedical & Translational Informatics, Geisinger Medical Center, Danville, Penn.
FAU - Liu, Anastasia Yian
AU  - Liu AY
AD  - Department of Cell and Systems Biology, University of Toronto, Toronto, Ontario, 
      Canada.
FAU - Zhang, Li
AU  - Zhang L
AD  - Division of Anesthesiology, Geisinger Medical Center, Danville, Penn.
FAU - Wu, Xianren
AU  - Wu X
AD  - Division of Anesthesiology, Geisinger Medical Center, Danville, Penn.
FAU - Shi, Shuai
AU  - Shi S
AD  - Gillings School of Global Public Health, University of North Carolina-Chapel 
      Hill, Chapel Hill, NC.
FAU - Elmore, James R
AU  - Elmore JR
AD  - Department of Vascular Surgery, Geisinger Medical Center, Danville, Penn.
FAU - Zhang, Xiaopeng
AU  - Zhang X
AD  - Division of Anesthesiology, Geisinger Medical Center, Danville, Penn. Electronic 
      address: xzhang1@geisinger.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
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 - J Vasc Surg. 2019 Jul;70(1):285. PMID: 31230647
EIN - J Vasc Surg. 2019 Nov;70(5):1730. Abstract corrected. PMID: 31653393
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antithrombins/adverse effects/*therapeutic use
MH  - *Endovascular Procedures/adverse effects/mortality
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Ischemic Attack, Transient/etiology
MH  - Myocardial Infarction/etiology
MH  - Observational Studies as Topic
MH  - Patient Safety
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - Peripheral Vascular Diseases/mortality/*therapy
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke/etiology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anticoagulation
OT  - Bivalirudin
OT  - Endovascular procedures
OT  - Hemorrhage
OT  - Heparin
EDAT- 2019/06/25 06:00
MHDA- 2020/01/28 06:00
CRDT- 2019/06/25 06:00
PHST- 2018/07/18 00:00 [received]
PHST- 2018/12/11 00:00 [accepted]
PHST- 2019/06/25 06:00 [entrez]
PHST- 2019/06/25 06:00 [pubmed]
PHST- 2020/01/28 06:00 [medline]
AID - S0741-5214(19)30181-8 [pii]
AID - 10.1016/j.jvs.2018.12.037 [doi]
PST - ppublish
SO  - J Vasc Surg. 2019 Jul;70(1):274-284.e5. doi: 10.1016/j.jvs.2018.12.037.