Comparison of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in patients undergoing an invasive strategy: A meta-analysis of randomized clinical trials

• Published in: International journal of cardiology 2011-11, Vol.152 (3), p.369-374
• Main Authors: Lee, Michael S, Liao, Hsini, Yang, Tae, Dhoot, Jashdeep, Tobis, Jonathan, Fonarow, Gregg, Mahmud, Ehtisham
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Biological and medical sciences; Bivalirudin; Cardiology. Vascular system; Cardiovascular; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Diseases of the cardiovascular system; Drug Therapy, Combination; Glycoprotein IIb/IIIa inhibitors; Heparin; Heparin - administration & dosage; Hirudins - administration & dosage; Humans; Medical sciences; Peptide Fragments - administration & dosage; Percutaneous coronary intervention; Platelet Aggregation Inhibitors - administration & dosage; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic - methods; Recombinant Proteins - administration & dosage
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.08.007

Abstract Objective This meta-analysis was performed to assess the efficacy and safety of bivalirudin compared with unfractionated heparin or enoxaparin plus glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention (PCI). Background Pharmacotherapy for patients undergoing PCI includes bivalirudin, heparin, and GP IIb/IIIa inhibitors. We sought to compare ischemic and bleeding outcomes with bivalirudin versus heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI. Methods A literature search was conducted to identify fully published randomized trials that compared bivalirudin with heparin plus GP IIb/IIIa inhibitors in patients undergoing PCI. Results A total of 19,772 patients in 5 clinical trials were included in the analysis (9785 patients received bivalirudin and 9987 patients received heparin plus GP IIb/IIIa inhibitors during PCI). Anticoagulation with bivalirudin, as compared with heparin plus glycoprotein IIb/IIIa inhibitors, results in no difference in major adverse cardiovascular events (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.96 to 1.19), death (OR 0.93, 95% CI 0.72 to 1.21), or urgent revascularization (OR 1.06, 95% CI 0.86 to 1.30). There is a trend towards a higher risk of myocardial infarction (OR 1.12, 95% CI 0.99 to 1.28) but a significantly lower risk of TIMI major bleeding with bivalirudin (OR 0.55, 95% CI 0.44 to 0.69). Conclusion In patients who undergo PCI, anticoagulation with bivalirudin as compared with unfractionated heparin or enoxaparin plus GP IIb/IIIa inhibitors results in similar ischemic adverse events but a reduction in major bleeding.