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

Lee, Michael S.; Liao, Hsini; Yang, Tae Hyun; Dhoot, Jashdeep; Tobis, Jonathan M.; Fonarow, Gregg C.; Mahmud, Ehtisham

doi:10.1016/j.ijcard.2010.08.007

Cited by 41 publications

(25 citation statements)

References 27 publications

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“…Adjunctive treatment with platelet glycoprotein IIb/IIIa antagonists substantially reduces the incidence of ischemic complications after PTCA or stent placement [ 538 -543 ]. Similar results are obtained with the use of bivalirudin alone [ 544 ]. The rate of restenosis may be similar to that of stable angina, although reports differ on this point [ 480 , 485 , 489 , 545 -548 ].…”

Section: Acute Coronary Syndromessupporting

confidence: 75%

Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease

Wilson

2015

Coronary Artery Disease

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Both percutaneous revascularization and coronary artery bypass surgery are very effective in relieving angina pectoris. The principal means by which revascularization alters survival prognosis appears to be a reduction in infarct size and infarct-related mortality, rather than a reduction in the incidence of infarction or unstable angina.Saphenous vein grafts have a limited durability, as evidenced clinically by the return of symptoms in surgically bypassed patients, often within 5 years, and the increased morbidity that follows. In contrast to saphenous vein grafts, internal mammary conduits are remarkably resistant to atherosclerosis, having 10-year patency rates of 80-95 %. The internal mammary artery performs best when used to bypass the left anterior descending coronary artery. Other arterial conduits used today include the radial artery and the inferior epigastric arteries. Thus, it is possible to perform multivessel revascularization without using a saphenous vein graft. Off-pump coronary bypass is generally equivalent to the standard procedure, but it reduces perioperative infl ammation and morbidity and improves outcomes in selected high-risk patients. Atrial fi brillation is the most common complication of coronary artery bypass surgery, occurring in 25-30 % of patients. The risk of angiographic restenosis and need for repeat revascularization is markedly reduced in patients who receive stents that elute a variety of antiproliferative drugs into native coronary lesions, small vessels, and saphenous vein grafts, both after myocardial infarction and in patients with diabetes mellitus. Balloon angioplasty and stent-percutaneous coronary revascularization are effective forms of therapy for patients with non-ST-elevation myocardial infarction, unstable angina, or ST-elevation myocardial infarction aborting the acute event. For the treatment of stable angina, percutaneous therapy is principally for the control of angina. The risks and longterm effi cacy associated with revascularization procedures must be weighed against the prognosis for survival and myocardial infarction that is estimated according to clinical, physiological, and anatomic criteria. Revascularization procedures do not alter the natural history of atherosclerosis, only the likelihood of surviving as the disease progresses. Therefore, every effort should be made to control risk factors for aberrant metabolism, including obesity, diabetes mellitus, hyperlipidemia, and smoking.

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Section: Acute Coronary Syndromessupporting

confidence: 75%

Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease

Wilson

2015

Coronary Artery Disease

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“…14 Second, recent meta-analyses of randomized trials have reported a marked decrease of bleeding events but a neutral impact on mortality by bivalirudin compared with heparin monotherapy 26 or heparin plus glycoprotein IIb/IIIa inhibitors. 27 By reporting a significant reduction only in access site bleeding (a weaker correlate of mortality than non-access site bleeding), the current study may offer some explanation for the bleeding reduction-mortality relationship in patients treated with bivalirudin.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Access and Non–Access Sites Bleeding After Percutaneous Coronary Intervention

Ndrepepa

Neumann

Richardt

et al. 2013

Circ: Cardiovascular Interventions

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Background-Little is known about the impact of bleeding site on mortality after percutaneous coronary intervention.The aim of this study was to assess the impact of access and non-access site bleeding within 30 days after percutaneous coronary intervention on mortality. Methods and Results-This study represents a pooled patient-level analysis of 14 180 patients recruited in 7 randomized trials. Access and non-access site bleeding were assessed using the Bleeding Academic Research Consortium criteria. The primary outcome was 1-year mortality. Follow-up was complete in 97.5% of the patients. There were 414 deaths within the first year after percutaneous coronary intervention: 44 deaths among patients with access site bleeding, 60 deaths among patients with non-access site bleeding, and 310 deaths among patients without bleeding (Kaplan-Meier estimates of mortality, 4.5%, 10.0%, and 2.5%, respectively; adjusted hazard ratio, 1.72 [95% confidence interval, 1.19-2.47] for access site bleeding versus no bleeding; hazard ratio, 2.78 [2.00-3.86] for non-access site versus no bleeding). The inclusion of non-access site bleeding (the absolute and relative integrated discrimination improvement, 0.005 and 8.9%; P=0.031) but not of access site bleeding (the absolute and relative integrated discrimination improvement, 0.0015 and 2.7%; P=0.084) was associated with an improvement of the discriminatory power of multivariable model for mortality prediction. Conclusions-Both access and non-access site bleeding events occurring within 30 days of a percutaneous coronary intervention are independently associated with an increased risk of 1-year mortality. Non-access site bleeding is a stronger correlate of mortality than access site bleeding, and it improves the discriminatory power of models for mortality prediction. (Circ Cardiovasc Interv. 2013;6:354-361.)

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“…The highest level of evidence supporting the use of bivalirudin during PCI comes from a pooled analysis of fi ve large RCTs comparing bivalirudin with heparin plus GP IIb/IIIa inhibitors in patients without HIT 138 (Table S9). This analysis of .…”

Section: Bivalirudinmentioning

confidence: 99%

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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Dans

Moores

et al. 2012

Chest

855

335

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

Cited by 41 publications

References 27 publications

Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease

Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease

Prognostic Value of Access and Non–Access Sites Bleeding After Percutaneous Coronary Intervention

Treatment and Prevention of Heparin-Induced Thrombocytopenia

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