Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis

Abstract

In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32–0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37–2.13), myocardial infarction (OR, 0.79; CrL, 0.40–1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45–0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

Bivalirudin versus heparin in STEMI after BRIGHT-4 trial: an updated meta-analysis

“…Interestingly, the VALIDATE-SWEDEHEART trial with the STEMI cohort showed no difference between the two groups with regards to all-cause mortality [29]. In the short term as well as in the long term, bivalirudin had a protective effect on the risk of all-cause mortality compared to heparin therapy as reported by Kinnaird et al (at 30 days: 1.9% vs. 3.4%, OR = 0.55; 95%CL, 0.32-0.95; at one year: bivalirudin vs. heparin: 3.3% vs. 6.4%, OR = 0.50; 95%CL = 0.31-0.79) [42]. In a retrospective analysis by Pinto et al involving 59 917 STEMI PCIs, bivalirudin reduced the in-hospital mortality significantly compared to heparin=GPI (OR: 0.80,95% CI: 0.67-0.95) [43].…”

“…in their meta-analysis (Bivalirudin vs. Heparin; 2.6% vs. 3% respectively, OR = 0.84; 95%CI, 0.69–1.02; P = 0.08) [36], Kinnaird et al . (at 30 days: 1.4% vs. 1.8%, OR = 0.79; 95% CL, 0.40–1.55; at one year: 2.4% vs. 3.7%, OR = 0.63; 95%CL, 0.34–1.16) [42], Bittl et al . (OR = 1.09; 95% CI, 1.00–1.19) [39], and Zhang et al .…”

“…In the short term as well as in the long term, bivalirudin had a protective effect on the risk of all-cause mortality compared to heparin therapy as reported by Kinnaird et al . (at 30 days: 1.9% vs. 3.4%, OR = 0.55; 95%CL, 0.32–0.95; at one year: bivalirudin vs. heparin: 3.3% vs. 6.4%, OR = 0.50; 95%CL = 0.31–0.79) [42]. In a retrospective analysis by Pinto et al .…”