Comprehensive Meta-Analysis of Safety and Efficacy of Bivalirudin Versus Heparin With or Without Routine Glycoprotein IIb/IIIa Inhibitors in Patients With Acute Coronary Syndrome

Abstract

Overall, bivalirudin in ACS patients is associated with a significant reduction of major bleeding compared with heparin plus routinely administered GPI, but with a marked increase in ST rates compared with heparin with or without GPI.

Comparative efficacy and safety of anticoagulant strategies for acute coronary syndromes

“…This meta-analysis agrees with the findings of two important recent pairwise meta-analyses comparing bivalirudin vs UFH (22,23); the current meta-analysis, however, substantially differs in design from the latter by incorporating the most recent evidence on all parenteral anticoagulant strategies in ACS, instead of focusing on one comparison alone. Thus, with a total of 117,353 patients, this represents the largest anticoagulant database ever analysed and the first overview of the relative merits and limitations of such strategies in the setting of ACS.…”

Improving management of STEMI patients treated with primary PCI: Pharmacotherapy, renal function estimation and gender perspective

“…Notably, none of the earlier studies was powered to detect differences in mortality. Consistently with our results, a recent meta-analysis, including the five most recent RCTs with more than 10 000 patients, 177 showed no difference in short term mortality between bivalirudin±GPI and UFH±GPI. In concordance with the BRIGHT trial, lack of difference between the two treatment strategies persisted at one-year follow-up.…”

“…More frequent use of GPIs with UFH in our study, may obviously have contributed to the increased bleeding rate. 177 Anyhow, GPIs may have still have a role in selected patients, but the optimal rate remains unclear. 52,53,184 In contrast to previous studies we did not observe higher rate of ST associated with bivalirudin, after adjustment for baseline differences 49,51,176 .…”

“…In accordance with our results, recent studies and meta-analyses have not confirmed a lower re-infarction rate with bivalirudin compared to UFH± GPI, despite the superior safety profile of bivalirudin. 177,188 Given the current conflicting evidence, our study provides important information regarding the efficacy and safety (short and long-term) of the most commonly used antithrombotic strategies during PPCI in a large real-world population with STEMI.…”

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

“…6 Prolonged dual antiplatelet therapy (beyond 12 months), while protecting against thrombosis, will invariably increase the risk of major bleeding with an uncertain net impact on patient outcomes after percutaneous coronary intervention. [29][30][31] This benefit-risk dualism has raised controversies around the optimal duration of dual antiplatelet therapy that would maximise the effect against stent thrombosis while minimising the associated bleeding risk. As a result, recent randomised controlled trials have adopted a triad of duration models: short term, 12 months, and beyond 12 months.…”