Efficacy and safety of bivalirudin for percutaneous coronary intervention in acute coronary syndromes: a meta-analysis of randomized-controlled trials

Nührenberg, Thomas; Hochholzer, Willibald; Mashayekhi, Kambis; Ferenc, Mirosław; Neumann, Franz‐Josef

doi:10.1007/s00392-018-1251-1

Cited by 33 publications

(11 citation statements)

References 31 publications

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“…More recently, a meta-analysis updated for the results of VALIDATE-SWEDEHEART confirmed that bivalirudin compared with heparin was associated with a similar incidence of all-cause death and ischaemic events after PCI for ACS. 710 A significant association of bivalirudin with decreased risk of bleeding was only found with unbalanced use of GP IIb/IIIa inhibitors in conjunction with heparin. In summary and based on the above-mentioned trials, UFH is primarily recommended as an anticoagulant for PCI.…”

Section: Peri-interventional Treatmentmentioning

confidence: 99%

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2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

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Section: Peri-interventional Treatmentmentioning

confidence: 99%

“…IIa C Bivalirudin (0.75 mg/kg bolus, followed by 1.75 mg/kg/h for up to 4 h after the procedure) may be considered as an alternative to UFH. 163,708,710,714,728 IIb A…”

Section: Iia Bmentioning

confidence: 99%

2018 ESC/EACTS Guidelines on myocardial revascularization

Neumann¹,

Ahlsson²,

Alfonso³

et al. 2018

European Heart Journal

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5,252

2,078

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“…Previous record demonstrated that STEMI and NSTEMI groups are semblable in the efficacy. 27 With regards to stent thrombosis, we found no significant difference in the STEMI group. However, we cannot draw definitive conclusions because only a small number of trials have studied stent thrombosis.…”

Section: Discussionmentioning

confidence: 57%

Practicability of Bivalirudin plus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

Liu

et al. 2021

Clin Appl Thromb Hemost

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A variety of antithrombotic drugs are used during percutaneous coronary interventions (PCIs). We aimed to investigate the practicability of the use of bivalirudin and GPIs in patients receiving PCI. We searched 7 of 629 relevant records from PubMed, the Cochrane Library, EMBASE, and Web of Science for randomised controlled trials. There were no significant differences in the rates of major adverse cardiac events (MACE) between bivalirudin plus GPI and heparin (all P > .05). Bivalirudin plus planned GPI was similar to bivalirudin monotherapy in terms of the risk of MACE (risk ratio [RR] = 1.07; 95% confidence interval [CI] = .91 − 1.27; P = .55). Bivalirudin plus provisional GPI was associated with lower bleeding risk (RR = .57; 95% CI = .47 − .69; P < .01) compared to using heparin plus GPI. Compared to bivalirudin alone, bivalirudin plus planned GPI evidently increased bleeding risk (RR = 2.20; 95% CI = 1.73 − 2.79; P < .01). Patients receiving bivalirudin or heparin therapy had semblable efficacy endpoints, but those receiving bivalirudin had a significantly lower bleeding risk. For high-risk bleeding patients, bivalirudin plus provisional GPI can have a better antithrombotic effect than heparin, without increasing the bleeding risk.

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“…In percutaneous coronary artery interventions (PCI) and transcatheter aortic valve replacements (TAVR), multiple studies have provided evidence on the comparable efficacy of heparin and bivalirudin as intraprocedural anticoagulants (9,10). A trend towards the lower incidence of access or non-access hemorrhagic complications has also been indicated in several literature pieces, but this is not universally acknowledged (11,12). This has led to an interest in investigating whether the use of bivalirudin can also provide another option of intraprocedural pharmacology in LAAO.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of bivalirudin versus heparin in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion

Zhang¹,

Jin²,

Kong³

et al. 2021

Ann Transl Med

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Background: Prior studies have suggested that patients with atrial fibrillation (AF) referred for left atrial appendage occlusion (LAAO) are confronted with considerable risk of periprocedural thromboembolism and hemmorhagic events. The purpose of this study was to evaluate the safety and feasibility of bivalirudin during LAAO.Methods: This retrospective, observational study included 420 AF patients who were evaluated as being at high risk of stroke or bleeding and indicated for LAAO at our center between June 2018 and June 2019 (158 with bivalirudin and 262 with heparin). The primary outcome was the incidence of any bleeding within 48 hours of LAAO. Secondary outcomes were major adverse cardiac events (MACE) between 48 hours and 60 days post-procedure and overall bleeding events during follow up.Results: No significant difference was observed between bivalirudin and heparin for major periprocedural bleeding (1.27% for bivalirudin vs. 2.29% for heparin, P=0.716) or minor bleeding (1.27% vs. 1.15%, P>0.9). At 48 hours post-procedure, strokes occurred at a rate of 0.63% in the bivalirudin group and 1.15% in the heparin group (P>0.9), and one case treated with bivalirudin developed systemic embolization. At 60 days, the rates of MACE (1.90% vs. 2.29%, P>0.9), a device-related thrombus (DRT) (1.27% vs. 1.52%, P>0.9), and overall bleeding events (5.06% vs. 4.96%, P=0.963) were comparable between the 2 cohorts. Upon Kaplan-Meier survival analysis, early safety during the 60-day follow-up was 93.67% in the bivalirudin group and 91.60% in the heparin group (P=0.570).Conclusions: Bivalirudin has a comparable safety and efficacy profile to heparin as an intraprocedural anticoagulant, but currently, it should still be reserved for patients in which heparin is contraindicated.

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Efficacy and safety of bivalirudin for percutaneous coronary intervention in acute coronary syndromes: a meta-analysis of randomized-controlled trials

Abstract: Compared with heparin, bivalirudin was associated with a similar incidence of ischemic events following PCI for ACS. An association of bivalirudin with decreased bleeding was not seen with balanced use of GPI.

Cited by 33 publications

References 31 publications

2018 ESC/EACTS Guidelines on myocardial revascularization

2018 ESC/EACTS Guidelines on myocardial revascularization

Practicability of Bivalirudin plus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis

Clinical outcomes of bivalirudin versus heparin in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion

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