Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis

Abstract

Background Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05). Conclusion Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

Effectiveness and safety of bivalirudin in elderly patients with coronary artery disease undergoing percutaneous coronary intervention: A real‐world study

“…Our results demonstrated that bivalirudin was associated with a significant reduction in any bleeding compared with UFH. This finding is consistent with what has been reported earlier 22 . These results proved that bivalirudin provided additional beneficial effects in elderly patients undergoing PCI.…”

“…This finding is consistent with what has been reported earlier. 22 These results proved that bivalirudin provided additional beneficial effects in elderly patients undergoing PCI.…”

Anticoagulation and Antiplatelet Agents in Peripheral Arterial Interventions

“…The direct thrombin inhibitors function by directly inhibiting factor IIa, also known as thrombin. [26][27][28] The most used direct thrombin inhibitors are bivalirudin and argatroban, which are administered parenterally, and dabigatran, which is available in an oral formulation. These may be employed intraprocedurally for patients with heparin-induced thrombocytopenia (HIT) and as a bridge to an oral regimen postprocedurally.…”

“…These may be employed intraprocedurally for patients with heparin-induced thrombocytopenia (HIT) and as a bridge to an oral regimen postprocedurally. 27 28 Dabigatran has been used as an alternative anticoagulant in patient with peripheral arterial disease; however, there have been no large clinical trials evaluating its use after arterial revascularization. 14…”

Iliac Endovascular Intervention Without Procedural Anticoagulation

“…4 Those disadvantages have led to the use of bivalirudin as a primary anticoagulant during PVIs. [5][6][7] A randomized, double-blind, prospective study demonstrated that in the treatment of uncomplicated coronary lesions and in the presence of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, elective PCIs could be safely performed without procedural anticoagulation and were associated with a reduced incidence of bleeding complications. 8 In contrast to PCI, a long guiding catheter is not a necessity during PVI.…”