A systematic review and meta-analysis of bivalirudin application in peripheral endovascular procedures

Abstract

Objective: The direct thrombin inhibitor bivalirudin (BIV) was shown to be superior to unfractionated heparin (UFH) in percutaneous coronary interventions for reducing procedural blood loss. The aim of this study was to compare outcome profiles of BIV and UFH in peripheral endovascular procedures (PEPs) by synthesizing the currently available data. Methods: Following the PRISMA statement, we conducted a comprehensive literature search using Medline, Cochrane CENTRAL, PubMed, EMBASE, CINAHL Google scholar, and clinicaltrials.gov. We recruited randomized, controlled trials and well-conducted observational studies that compared UFH and BIV in PEPs requiring anticoagulation, excluding endovascular cardiac procedures and coronary interventions. Random-effects meta-analyses were conducted to compare the outcome profiles of these two agents. Results: Thirteen articles containing 17 studies involving a total of 21,057 patients were enrolled. Of these, 2 were randomized controlled trials, 2 were prospective cohort studies, and 10 were retrospective studies. There were no significant differences between BIV and UFH in terms of procedural success rates, major and minor perioperative bleeding, transfusion, perioperative transient ischemic attack, or hemorrhagic strokes. However, compared with UFH, BIV had significantly lower odds ratios (OR) of perioperative mortality (OR, 0.58; 95% confidence interval [CI], 0.40-0.86), major adverse cardiovascular events (OR, 0.65; 95% CI, 0.51-0.83), net adverse clinical events (OR, 0.75; 95% CI, 0.63-0.88), perioperative myocardial infarction (OR, 0.73; 95% CI, 0.55-0.98), major vascular complications (OR, 0.59; 95% CI, 0.39-0.91), and minor vascular complications (OR, 0.58; 95% CI, 0.40-0.84). Conclusions: Compared with UFH, PEPs using BIV had comparable procedural success rates and odds of perioperative transient ischemic attack and hemorrhagic stroke. However, procedures with BIV had a lower but nonsignificant odds of perioperative bleeding and transfusion. Depending on the procedures conducted, the patients who received BIV will have reduced or comparable odds of perioperative mortality, myocardial infarction, major adverse cardiovascular events, net adverse clinical events, and major and minor vascular complications. Therefore, BIV may be chosen solely as an alternative procedural anticoagulant to UFH for PEPs. (

Bivalirudin vs. heparin in paediatric and adult patients on extracorporeal membrane oxygenation: A meta‐analysis

“…reported no difference regarding major perioperative bleeding in patients undergoing peripheral endovascular procedures treated with BIV vs . UFH 30 . Compared with UFH, Omran et al .…”

“…Hu et al reported no difference regarding stroke events in patients undergoing peripheral endovascular procedures treated with BIV vs. UFH. 30 Differences between studies require more rigorous studies to confirm comparisons.…”

Anticoagulation in Peripheral Artery Disease: Are We There Yet?

“…23 A contemporary systematic review has analysed the efficacy of BIV versus UFH in peripheral endovascular interventions excluding intracardiac procedures. 24 Generally, patients who received BIV had significantly reduced risks of MACCE, net adverse clinical events, major and minor vascular complications, compared with the unfractionated UFH group. Patients who received BIV had a lower but non-significant odds of major bleeding (OR 0.72; 95% CI [0.47-1.11], minor bleeding (OR 0.74; 95% CI [0.55-1.00]) and transfusion.…”

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

“…A heparinhatás felfüggesztésére protamin-szulfát használható, melynek alkalmazásakor súlyos reakciókat -úgymint hypotensio, bradycardia vagy anafilaxia -is leírtak, és melynek adásával kapcsolatban még kevesebb a konszenzus, mint a heparin használatával [27]. A heparinalkalmazás lehetséges alternatívája lehet a bivalirudinkezelés, amely a kimeneteli tényezők némelyikében előnyösebbnek bizonyult [41]. A gyógyszeres kezelés óvatos mérlegelése mellett a vérzést megelőző stratégiák további tényezői (behatolási hely választása, kompreszszió, érzáró eszközök) szintén fontosak [42], a perifériás intervenciók esetén is odafigyelést igényelnek.…”