Heparin is Not Inferior to Bivalirudin in Percutaneous Coronary Intervention—Focusing on the Effect of Glycoprotein IIb/IIIa Inhibitor Use

Abstract

Our aim was to compare the efficacy and safety of bivalirudin (Biv) versus heparin (Hep) with or without similar usage rate of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI). The PubMed and EMbase were searched. Randomized trials comparing Biv versus Hep were eligible for inclusion. With imbalanced GPI use, Biv had significantly lower major bleeding (pooled risk ratio [RR], 0.67; 95% confidence interval [CI], 0.54-0.83) without difference in mortality (pooled RR, 0.95; 95% CI, 0.80-1.14). With comparable GPI use, no significant difference was observed in major bleeding (pooled RR, 0.95; 95% CI, 0.82-1.10) and mortality (pooled RR, 1.13; 95% CI, 0.85-1.50). With no GPI use, Biv was associated with numerically higher mortality (pooled RR, 1.17; 95% CI, 0.83-1.65) without significant difference in major bleeding (pooled RR, 0.81; 95% CI, 0.64-1.02). In conclusion, when comparing different anticoagulants during PCI, the effect of GPIs should not be underestimated. Heparin as such was found noninferior to Biv.

Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention

“…Recent trials and our meta-analysis have posed questions on the superiority of bivalirudin compared to heparin for reducing the risk of major bleeding. 23,24 Transradial PCI has shown consistently encouraging results for preventing bleeding. The rate of use of TRI is paradoxically low in women.…”

Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…The improved safety of bivalirudin-based regimens could be largely attributed to the more frequent co-administration of GPIs with heparin. However, when the rate of GPI use was balanced between bivalirudin-based regimens and heparin-based regimens, there was no difference in the incidence of major bleeding (Huang et al, 2015). …”

“…In this scenario, the effects of GPI use should not be underestimated when comparing different anticoagulants during PCI (Huang et al, 2015). Routine GPI use in addition to pre-treatment with loading doses of clopidogrel, have significantly increased the risk of bleeding complications due to the excessively enhanced anti-platelet effect (Dong et al, 2013).…”