Eliano Pio Navarese1, Volker Schulze2, Felicita Andreotti3, Mariusz Kowalewski4, Michalina Kołodziejczak5, David E Kandzari6, Tienush Rassaf2, Bartosz Gorny3, Maximilian Brockmeyer2, Christian Meyer2, Sergio Berti7, Jacek Kubica5, Malte Kelm2, Marco Valgimigli8. 1. Invasive Cardiology, National Research Council Institute of Clinical Physiology, Pisa, Italy; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany. Electronic address: eliano.navarese@alice.it. 2. Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany. 3. Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany; Department of Cardiovascular Science, Catholic University, Rome, Italy. 4. Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany; Department of Cardiology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland. 5. Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany; Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland. 6. Piedmont Heart Institute, Atlanta, Georgia. 7. Invasive Cardiology, National Research Council Institute of Clinical Physiology, Pisa, Italy; Cardiothoracic Department, Heart Hospital, Fondazione Toscana Gabriele Monasterio, Massa, Italy. 8. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS). BACKGROUND: Bivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear. METHODS: A total of 13 randomized, controlled trials involving 24,605 patients were included. RESULTS: There was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly. CONCLUSIONS: Overall, bivalirudin in ACS patients is associated with a significant reduction of major bleeding compared with heparin plus routinely administered GPI, but with a marked increase in ST rates compared with heparin with or without GPI.
OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS). BACKGROUND: Bivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear. METHODS: A total of 13 randomized, controlled trials involving 24,605 patients were included. RESULTS: There was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly. CONCLUSIONS: Overall, bivalirudin in ACS patients is associated with a significant reduction of major bleeding compared with heparin plus routinely administered GPI, but with a marked increase in ST rates compared with heparin with or without GPI.
Authors: Abdul Hafeez Ahmad Hamdi; Ahmad Fauzi Dali; Thimarul Huda Mat Nuri; Muhammad Syafiq Saleh; Noor Nabila Ajmi; Chin Fen Neoh; Long Chiau Ming; Amir Heberd Abdullah; Tahir Mehmood Khan Journal: Front Pharmacol Date: 2017-07-11 Impact factor: 5.810
Authors: Kerstin Piayda; Laura Kleinebrecht; Shazia Afzal; Roland Bullens; Iris Ter Horst; Amin Polzin; Verena Veulemans; Lisa Dannenberg; Anna Christina Wimmer; Christian Jung; Florian Bönner; Malte Kelm; Katharina Hellhammer; Tobias Zeus Journal: Eur J Med Res Date: 2018-07-31 Impact factor: 2.175