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
Standard
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. / Navarese, Eliano Pio; Schulze, Volker; Andreotti, Felicita; Kowalewski, Mariusz; Kołodziejczak, Michalina; Kandzari, David E; Rassaf, Tienush; Gorny, Bartosz; Brockmeyer, Maximilian; Meyer, Christian; Berti, Sergio; Kubica, Jacek; Kelm, Malte; Valgimigli, Marco.
In: JACC-CARDIOVASC INTE, Vol. 8, No. 1 Pt B, 01.2015, p. 201-213.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - 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
AU - Navarese, Eliano Pio
AU - Schulze, Volker
AU - Andreotti, Felicita
AU - Kowalewski, Mariusz
AU - Kołodziejczak, Michalina
AU - Kandzari, David E
AU - Rassaf, Tienush
AU - Gorny, Bartosz
AU - Brockmeyer, Maximilian
AU - Meyer, Christian
AU - Berti, Sergio
AU - Kubica, Jacek
AU - Kelm, Malte
AU - Valgimigli, Marco
N1 - Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2015/1
Y1 - 2015/1
N2 - OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS).BACKGROUND: Bivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear.METHODS: A total of 13 randomized, controlled trials involving 24,605 patients were included.RESULTS: There was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly.CONCLUSIONS: 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.
AB - OBJECTIVES: The aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS).BACKGROUND: Bivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear.METHODS: A total of 13 randomized, controlled trials involving 24,605 patients were included.RESULTS: There was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly.CONCLUSIONS: 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.
KW - Acute Coronary Syndrome/blood
KW - Anticoagulants/adverse effects
KW - Blood Platelets/drug effects
KW - Chi-Square Distribution
KW - Coronary Thrombosis/etiology
KW - Hemorrhage/chemically induced
KW - Heparin/adverse effects
KW - Hirudins/adverse effects
KW - Humans
KW - Myocardial Infarction/etiology
KW - Odds Ratio
KW - Peptide Fragments/adverse effects
KW - Platelet Aggregation Inhibitors/adverse effects
KW - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
KW - Randomized Controlled Trials as Topic
KW - Recombinant Proteins/adverse effects
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jcin.2014.10.003
DO - 10.1016/j.jcin.2014.10.003
M3 - SCORING: Journal article
C2 - 25616926
VL - 8
SP - 201
EP - 213
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 1 Pt B
ER -
