Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis

被引:4
作者
Olmedo, Wilman [1 ]
Villablanca, Pedro A. [2 ]
Sanina, Cristina [1 ]
Walker, Jonathan [1 ]
Weinreich, Michael [1 ]
Brevik, Jeannine [1 ]
Avendano, Ricardo [1 ]
Bravo, Claudio A. [1 ]
Romero, Jorge [1 ]
Ramakrishna, Harish [3 ]
Babaev, Anvar [2 ]
Attubato, Michael [2 ]
Hernandez-Suarez, D. F. [5 ]
Cox-Alomar, P. [6 ]
Pyo, Robert [1 ]
Krishnan, Prakash [4 ]
Wiley, Jose [1 ]
机构
[1] Montefiore Med Ctr, Albert Einstein Coll Med, Div Cardiol, Bronx, NY 10467 USA
[2] NYU, Sch Med, Div Cardiol, New York, NY USA
[3] Mayo Clin, Coll Med, Div Cardiovasc & Thorac Anesthesiol, Scottsdale, AZ USA
[4] Mt Sinai Med Ctr, Div Cardiol, New York, NY 10029 USA
[5] Univ Puerto Rico, Sch Med, Div Med, Cardiol Sect, San Juan, PR 00936 USA
[6] Louisiana State Univ, Sch Med, Div Med, Cardiol Sect, New Orleans, LA USA
关键词
Bivalirudin; heparin; peripheral percutaneous interventions; mortality; bleeding; access site complications; ACUTE CORONARY SYNDROMES; UNFRACTIONATED HEPARIN; PRIMARY ANGIOPLASTY; VASCULAR INTERVENTIONS; EARLY REINFARCTION; ARTERY-DISEASE; PREDICTORS; RISK; EFFICACY; IMPACT;
D O I
10.1177/1708538118807522
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Background Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39-0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50-0.78), major bleeding (risk ratio 0.61, 95% CI 0.39-0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47-0.92), and access site complications (risk ratio 0.66, 95% CI 0.51-0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57-1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59-1.28), stroke (risk ratio 0.77, 95% CI 0.59-1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29-2.02), or amputations (OR 0.75, 95% CI 0.53-1.05). Conclusion Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.
引用
收藏
页码:78 / 89
页数:12
相关论文
共 48 条
  • [1] AbuRahma Ali F, 2016, Adv Surg, V50, P235, DOI 10.1016/j.yasu.2016.04.004
  • [2] Allie David E, 2003, J Invasive Cardiol, V15, P334
  • [3] [Anonymous], EUR HEART J
  • [4] [Anonymous], 2014, REV MAN REVMAN COMP
  • [5] [Anonymous], 2016, NEWCASTLE OTTAWA SCA
  • [6] Novel Approaches for Preventing or Limiting Events (Naples) III Trial Randomized Comparison of Bivalirudin Versus Unfractionated Heparin in Patients at Increased Risk of Bleeding Undergoing Transfemoral Elective Coronary Stenting
    Briguori, Carlo
    Visconti, Gabriella
    Focaccio, Amelia
    Donahue, Michael
    Golia, Bruno
    Selvetella, Lucio
    Ricciardelli, Bruno
    [J]. JACC-CARDIOVASCULAR INTERVENTIONS, 2015, 8 (03) : 414 - 423
  • [7] Predictors and clinical implications of early reinfarction after primary angioplasty for ST-segment elevation myocardial infarction
    De Luca, Giuseppe
    Ernst, Nicolette
    van't Hof, Arnoud W. J.
    Ottervanger, Jan Paul
    Hoorntje, Jan C. A.
    Gosselink, A. T. Marcel
    Dambrink, Jan-Henk E.
    de Boer, Menko-Jan
    Suryapranata, Harry
    [J]. AMERICAN HEART JOURNAL, 2006, 151 (06) : 1256 - 1259
  • [8] Random-effects model for meta-analysis of clinical trials: An update
    DerSimonian, Rebecca
    Kacker, Raghu
    [J]. CONTEMPORARY CLINICAL TRIALS, 2007, 28 (02) : 105 - 114
  • [9] Efeovbokhan N, 2014, FUTUR CARDIOL, V10, P717, DOI [10.2217/FCA.14.50, 10.2217/fca.14.50]
  • [10] Predictors and impact of major Hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 trial
    Feit, Frederick
    Voeltz, Michele D.
    Attubato, Michael J.
    Lincoff, A. Michael
    Chew, Derek P.
    Bittl, John A.
    Topol, Eric J.
    Manoukian, Steven V.
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2007, 100 (09) : 1364 - 1369