Efficacy and safety of bivalirudin vs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention

Abstract

Background: This meta-analysis is to evaluate the efficacy and safety of bivalirudin in patients with ST-elevation myocardial infarction (STEMI). Methods: PubMed, Cochrane Library, Embase, CNKI, CBMdisc, and VIP database were searched. Randomized controlled trial (RCT) was selected and the meta-analysis was conducted by RevMan 5.1. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) and the primary safety endpoint was the incidence of major bleeding. Secondary efficacy endpoints were myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stock, mortality, and thrombocytopenia. The pooled risk ratios (RRs) with the corresponding 95% confidence intervals (CI) were used to assess the efficacy and safety of bivalirudin vs heparin. Results: Seven RCTs met the inclusion criteria, and 16,640 patients were included. We found that bivalirudin associated with lower risk of mortality (RR = 1.05; 95% CI = 0.74–1.49; P = .03; I 2 = 2%), major bleeding (RR = 0.64; 95% CI = 0.54–0.75; P < .00001; I 2 = 70%) and thrombocytopenia (RR = 0.39; 95% CI = 0.25–0.61; P < .0001; I 2 = 0) compared with heparin. However, the use of bivalirudin increase the risk of MI(RR = 1.37; 95% CI = 1.10–1.71; P = .004; I 2 = 25%) and ST(RR = 1.61; 95% CI = 1.05–2.47; P = .03; I 2 = 70%) and has similar risk of MACE (RR = 1.00; 95% CI = 0.90–1.11; P = .97; I 2 = 16%), TVR (RR = 1.43; 95% CI = 0.92–2.22; P = .11; I 2 = 46%) and stock (RR = 1.43; 95% CI = 0.92–2.22; P = .11; I 2 = 46%) compared with heparin used in STEMI patients. Conclusion: Bivalirudin associated with lower risk of mortality, major bleeding and thrombocytopenia compared with heparin. However, the use of bivalirudin increase the risk of MI and ST and has similar risk of MACE, TVR and stock compared with heparin used in STEMI patients.

Efficacy and Safety of Butorphanol Use in Patient-Controlled Analgesia: A Meta-Analysis

“…e following endpoints were also extracted: VAS score, RSS score, incidence of nausea, vomiting, itching, and dizziness. Additionally, information regarding blinding, random sequence generation, allocation concealment, indications for incomplete outcome data, indications for selective reporting, and other biases were also collected to evaluate the quality of the included investigations [8].…”

Comparison of Efficacy of Biliverdin vs Heparin in Patients with Stable Ischemic Heart Disease Undergoing Percutaneous Coronary Intervention

“…Interestingly, the use of biliverdin did not increase the risk of bleeding complications compared to heparin. Although the incidence of bleeding complications was not significantly different between the two groups, the lower incidence of thrombotic complications in the biliverdin group indicates that it may be a safer anticoagulant for use during PCI 9 . The logistic regression analysis showed that biliverdin use was independently associated with a lower risk of thrombotic complications, even after adjusting for baseline demographic and clinical characteristics.…”

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

“…In a prospective study by Shelton et al, there were lower MACE events in the bivalirudin group than in the heparin group but was NS (7.5% vs. 9.4%; P = 0.520) [37]. However, in the meta-analyses by Zhang et al [17]and Liu et al [38], there were no significant difference between the bivalirudin and heparin; (RR = 0.87; 95% CI = 0.74-1.02; P= 0.08; I 2 = 39%) and (RR = 1.00; 95% CI = 0.90-1.11; P= 0.97; I 2 = 16%) respectively, regarding the MACE among patients undergoing PCI for ACS.…”

“…[17]and Liu et al . [38], there were no significant difference between the bivalirudin and heparin; (RR = 0.87; 95% CI = 0.74–1.02; P = 0.08; I 2 = 39%) and (RR = 1.00; 95% CI = 0.90–1.11; P = 0.97; I 2 = 16%) respectively, regarding the MACE among patients undergoing PCI for ACS.…”