A Meta-analysis of Clinical Trials Evaluating the Impact of Bivalirudin-based Anticoagulation for Primary Percutaneous Coronary on Long-Term Mortality. Issue 1 (July 2021)

• Record Type: Journal Article
• Authors: Jagadish, Pooja S.; Le, Francis K.; Labroo, Ajay; Nasr, Abrar; Rashid, Abdul; Khan, Babar; Shah, Rahman
• Is Part Of: Journal of cardiovascular pharmacology. Volume 78:Issue 1(2021)
• Publication Date: 2021-07
• Subjects: bivalirudin -- heparin -- mortality -- coronary intervention; Cardiovascular Diseases -- drug therapy -- Periodicals; Cardiovascular System -- drug effects -- Periodicals; Cardiovascular pharmacology -- Periodicals; Cardiovascular agents -- Periodicals; Cardiovascular agents; Cardiovascular pharmacology; Periodicals; 615.7105
• DOI: 10.1097/FJC.0000000000001029
• Languages: English
• ISSNs: 0160-2446

Abstract

Abstract : Abstract: Bivalirudin and heparin are the principal anticoagulants used during primary percutaneous coronary intervention (PCI) for patients experiencing ST-elevation myocardial infarctions. Based on previous meta-analyses, bivalirudin improves 30-day mortality rates compared with heparin, especially when vascular access is predominantly femoral. However, no meta-analysis has yet reported whether this mortality benefit with bivalirudin persists beyond 30 days. Scientific databases and websites were searched to find randomized controlled trials, and risk ratios (RRs) were calculated using random effect models. Data from 4 trials were analyzed. Compared with heparin ± glycoprotein IIb/IIIa inhibitors, bivalirudin decreased all-cause mortality [RR, 0.81; 95% confidence interval (CI), 0.69–0.94; P = 0.008], cardiac mortality (RR, 0.72; 95% CI, 0.60–0.88; P = 0.001), and net adverse clinical events (RR, 0.83; 95% CI, 0.72–0.97; P = 0.016) at 1 year. In conclusion, a bivalirudin-based anticoagulation strategy during primary percutaneous coronary intervention significantly decreases the 1-year risks for all-cause mortality, cardiac mortality, and net adverse clinical events compared with heparin ± glycoprotein IIb/IIIa inhibitor. Abstract : Supplemental Digital Content is Available in the Text.