Will Bivalirudin Have an Impact in Peripheral Vascular Interventions?

Parikh, Sahil A.; Drachman, Douglas E.

doi:10.1161/circinterventions.115.003424

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…At present, bivalirudin is considered to have a similar effect as heparin in clinical application. 15 Several clinical studies have shown that bivalirudin has significant advantages in reducing perioperative complications, improving medical quality, and reducing medical cost. There have been some cost-effect clinical trials that compare the difference of economic evaluation.…”

Section: Introductionmentioning

confidence: 99%

A meta‐analysis and cost‐minimization analysis of bivalirudin versus heparin in high‐risk patients for percutaneous coronary intervention

Sun

Cui

Cao

et al. 2021

Pharmacology Res & Perspec

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This meta‐analysis was performed to compare the safety, efficacy, and pharmacoeconomic of bivalirudin versus heparin in high‐risk patients for percutaneous coronary interventions (PCI). Earlier meta‐analysis comparing bivalirudin and heparin during PCI demonstrated that bivalirudin caused less bleeding with more stent thrombosis. However, little data were available on the safety of bivalirudin versus heparin in high‐risk patients for PCI. Thus, we performed a meta‐analysis to evaluate the efficacy and safety in the “high‐risk” patients. A systematic search of electronic databases was conducted up to July 30, 2020. The Cochrane Risk of Bias assessment tool was used to assess the quality of included studies. The primary outcomes were all‐cause death and major adverse cardiac events (MACE); secondary outcomes were major and minor bleeding, followed by a cost‐minimization analysis comparing bivalirudin and heparin using a local drug and medical costs reported in China. Subgroup analysis was based on the type of disease of the high‐risk population. Finally, a total of 10 randomized controlled trials involved 42,699 patients were collected. The Cochrane Risk of Bias Tool was employed to appraise the research quality. No significant difference was noted between bivalirudin and heparin regarding all‐cause death and MACE. However, subgroup analysis showed that bivalirudin caused less major bleeding in female (OR:0.65, 95% CI:0.53–0.79), diabetes (OR:0.55, 95%CI:0.42–0.73), and CKD (OR:0.59, 95%CI:0.63–1.65). The scatterers of the included literature were approximately symmetrical, and no research was outside the funnel plot. Additionally, cost‐minimization analysis showed that heparin was likely to represent a cost‐effective option compared with bivalirudin in China, with potential savings of 2129.53 Chinese Yuan (CNY) per patient for one PCI. Overall, the meta‐analysis showed that although bivalirudin appeared to have a lower risk of major bleeding rate, the overall effectiveness and safety between the two groups showed no significant difference in high‐risk patients for PCI. But the results of the cost‐minimization analysis showed that heparin could be a potential cost‐saving drug than bivalirudin in patients for PCI in China.

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Section: Introductionmentioning

confidence: 99%

A meta‐analysis and cost‐minimization analysis of bivalirudin versus heparin in high‐risk patients for percutaneous coronary intervention

Sun

Cui

Cao

et al. 2021

Pharmacology Res & Perspec

View full text Add to dashboard Cite

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Bivalirudin versus unfractionated heparin in peripheral vascular interventions

Omran

Enezate

Abdullah

et al. 2018

Cardiovascular Revascularization Medicine

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Percutaneous Therapies for Peripheral Artery Disease

Shishehbor

Jaff

2016

Circulation

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Percutaneous therapies for peripheral artery disease continue to evolve with new techniques and devices. Although guidelines-recommended therapies have impacted cardiovascular morbidity and mortality, endovascular interventions have been shown to reduce limb pain, improve quality of life, and prolong walking distance for those with claudication and to reduce amputation rates among those with critical limb ischemia. Novel devices such as drug-eluting stents and drug-coated balloons have improved patency for moderate-length lesions, whereas others allow treatment of heavily calcified and tortuous segments. New adjunctive devices to cross lesions and reduce or modify associated plaque have also been developed, although level 1 data regarding their efficacy are sparse. There has also been a better mechanistic understanding of lower extremity endovascular treatment using tools such as intravascular ultrasound. This information has highlighted the need for better stent size selection for the femoropopliteal arterial segments and larger balloon diameters for the tibial arteries. Moreover, a wound perfusion approach with direct in-line flow, the so-called angiosome approach, and reconstruction of the pedal loop have been advocated for improved wound healing. Technical advances such as the tibiopedal access and reentry methods have allowed crossing of lesions that were considered no option for the endovascular approach in the past. Collectively, there has been increased awareness, interest, and commitment by various specialty societies and organizations to advance the treatment of peripheral artery disease and critical limb ischemia. This is also evident by the recent coalition of 7 professional societies and organizations that represented >150 000 allied health professionals and millions of patients with peripheral artery disease at the 2015 Centers for Medicaid and Medicare Services Medicare Evidence Development and Coverage Analysis Committee meeting. The percutaneous therapies for peripheral artery disease continue to evolve with longer follow-up with randomized data and larger prospective registries. In the future, it is hopeful that we will treat the lower extremity arteries according to segments, taking into account plaque morphology, luminal versus subintimal crossing, location, and stenotic versus occlusive disease. Until then, we must identify the most cost-effective, efficacious, and safe treatment for each patient. The goal of this article is to aid the practicing vascular specialist consider the optimal choices for the management of patients with vascular disease.

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Will Bivalirudin Have an Impact in Peripheral Vascular Interventions?

Cited by 3 publications

References 12 publications

A meta‐analysis and cost‐minimization analysis of bivalirudin versus heparin in high‐risk patients for percutaneous coronary intervention

A meta‐analysis and cost‐minimization analysis of bivalirudin versus heparin in high‐risk patients for percutaneous coronary intervention

Bivalirudin versus unfractionated heparin in peripheral vascular interventions

Percutaneous Therapies for Peripheral Artery Disease

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