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

Abstract

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.

Occurrence and Risk Factors of Adverse Drug Reactions in Patients Receiving Bivalirudin as Anticoagulant During Percutaneous Coronary Intervention: A Prospective, Multi-Center, Intensive Monitoring Study

“…Bivalirudin, a synthetic analog of natural anticoagulant hirudin which consists of 20 amino acid peptides, is an explicit and irreversible thrombin inhibitor with concentrationdependent competitive and non-competitive thrombin repressing effect (8,9). Unlike the UFH, bivalirudin not only realizes expectable anticoagulant outcome with linear pharmacokinetic and pharmacodynamic properties, it also achieves quicker onset and has a shortened action period; but also reduces the influence of platelet function and bleeding, which makes it a potentially alternative option for anticoagulant during PCI (8)(9)(10)(11)(12). Clinically, several randomized trials have demonstrated the non-inferiority of bivalirudin vs. UFH plus glycoprotein IIb/IIIa inhibitors regrading ischemic events, but the superiority of lower bleeding risk in PCI procedures as anticoagulant (6,(12)(13)(14).…”