PT208 Bivalirudin versus Heparin alone in Primary PCI for ST-segment Elevation Myocardial Infarction

Shah, Nadim; Natarajan, D; Rafiudeen, Rifly; Ko, Soe K.; Taeed, Anis; Soon, Kean; Cox, Nicholas

doi:10.1016/j.gheart.2014.03.1976

Cited by 1 publication

(2 citation statements)

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“…And the nonequilibrium of GPIs has been put forward to be one of the possible reasons of different occurrence of major bleeding between Biv and Hep. 10,28 Hence, the conclusion might not be convincing that Biv outperforms Hep under the circumstance of different GPI use.…”

Section: Discussionmentioning

confidence: 99%

“…An untested but possible reason for this paradox may be the unequal usage rate of glycoprotein IIb/IIIa inhibitors (GPIs) between the Biv and Hep group in the previous trials. [7][8][9][10] In this meta-analysis, our aim was to compare the efficacy and safety of Biv versus unfractured Hep or lowmolecular-weight Hep with or without comparable usage rate of GPIs in patients undergoing PCI.…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Peng

et al. 2015

Angiology

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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.

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Section: Discussionmentioning

confidence: 99%