PMID- 31636795
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220410
IS  - 1923-2829 (Print)
IS  - 1923-2837 (Electronic)
IS  - 1923-2829 (Linking)
VI  - 10
IP  - 5
DP  - 2019 Oct
TI  - Bivalirudin Versus Heparin During Percutaneous Coronary Intervention in Patients 
      With Acute Myocardial Infarction.
PG  - 278-284
LID - 10.14740/cr921 [doi]
AB  - BACKGROUND: The aim of the study was to compare the efficacy and safety of 
      bivalirudin versus unfractionated heparin (UFH) in patients with acute myocardial 
      infarction who undergo percutaneous coronary intervention (PCI). Earlier trials 
      comparing bivalirudin and UFH during PCI demonstrated that bivalirudin caused 
      less bleeding with more stent thrombosis. Since then, adjunct antiplatelet 
      strategies have evolved. Improved upstream platelet inhibition with potent P2Y12 
      inhibitors decreased the need for routine glycoprotein IIb/IIIa inhibitor (GPI), 
      resulting in similar outcomes among UFH and bivalirudin. Therefore, the role of 
      bivalirudin in modern PCI practices is questionable. METHODS: We utilized 
      Cochrane Review Manager (RevMan) 5.3 to perform a meta-analysis of seven 
      randomized controlled trials (RCTs) with 22,844 patients to compare bivalirudin 
      to UFH in patients with acute myocardial infarction requiring revascularization. 
      RESULTS: There was no difference between bivalirudin and UFH regarding major 
      adverse cardiac events (MACE), risk ratio (RR) 0.99, 95% confidence interval (CI) 
      0.87 - 1.12; P = 0.83) or cardiovascular mortality (RR 0.87, 95% CI 0.71 - 1.07; 
      P = 0.18). Bivalirudin increased acute stent thrombosis (RR 2.77, 95% CI 1.49 - 
      5.13; P = 0.001), which was only significant among ST-elevation myocardial 
      infarction (STEMI) only trials. Bivalirudin caused less major bleeding (RR 0.66, 
      95% CI 0.49 - 0.90; P = 0.007), which was negated when GPI was used provisionally 
      (RR 0.93, 95% CI 0.64 - 1.33; P = 0.67). CONCLUSIONS: Among patients with acute 
      myocardial infarction who underwent PCI, bivalirudin and UFH demonstrated similar 
      MACE and cardiovascular mortality. Bivalirudin increased acute stent thrombosis, 
      which was more remarkable among STEMI. Bivalirudin decreased major bleeding, but 
      this benefit was negated when GPI was used provisionally.
CI  - Copyright 2019, Patel et al.
FAU - Patel, Hiten
AU  - Patel H
AD  - Department of Cardiology, Cape Fear Valley Medical Center, Campbell University, 
      Fayetteville, NC, USA.
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Garris, Rana
AU  - Garris R
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Bhutani, Suchit
AU  - Bhutani S
AD  - Thomas Jefferson University Hospital, Philadelphia, PA, USA.
FAU - Shah, Priyank
AU  - Shah P
AD  - Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA, USA.
FAU - Rampal, Upamanyu
AU  - Rampal U
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Vasudev, Rahul
AU  - Vasudev R
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Melki, Gabriel
AU  - Melki G
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Ghalyoun, Bader Abu
AU  - Ghalyoun BA
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Virk, Hartaj
AU  - Virk H
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Bikkina, Mahesh
AU  - Bikkina M
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
FAU - Shamoon, Fayez
AU  - Shamoon F
AD  - St Joseph's Health, New York Medical College, Paterson, NJ, USA.
LA  - eng
PT  - Journal Article
DEP - 20191004
PL  - Canada
TA  - Cardiol Res
JT  - Cardiology research
JID - 101557543
PMC - PMC6785291
OTO - NOTNLM
OT  - Bivalirudin
OT  - Heparin
OT  - Percutaneous coronary angiography
OT  - STEMI
COIS- None to declare.
EDAT- 2019/10/23 06:00
MHDA- 2019/10/23 06:01
PMCR- 2019/10/01
CRDT- 2019/10/23 06:00
PHST- 2019/07/30 00:00 [received]
PHST- 2019/08/12 00:00 [accepted]
PHST- 2019/10/23 06:00 [entrez]
PHST- 2019/10/23 06:00 [pubmed]
PHST- 2019/10/23 06:01 [medline]
PHST- 2019/10/01 00:00 [pmc-release]
AID - 10.14740/cr921 [doi]
PST - ppublish
SO  - Cardiol Res. 2019 Oct;10(5):278-284. doi: 10.14740/cr921. Epub 2019 Oct 4.