Bivalirudin versus unfractionated heparin in patients with myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials

被引:2
|
作者
Al-Abdouh, Ahmad [1 ,8 ]
Mhanna, Mohammed [2 ]
Jabri, Ahmad [3 ]
Madanat, Luai [4 ]
Alhuneafat, Laith [5 ]
Mostafa, Mostafa Reda [6 ]
Kundu, Amartya [7 ]
Gupta, Vedant [7 ]
机构
[1] Univ Kentucky, Dept Med, Lexington, KY USA
[2] Univ Iowa, Dept Cardiovasc Med, Iowa City, IA USA
[3] Case Western Univ Metrohlth, Dept Cardiol, Cleveland, OH USA
[4] Beaumont Hosp, Dept Med, Detroid, MI USA
[5] Allegheny Hlth Network, Dept Internal Med, Pittsburgh, PA USA
[6] Rochester Reg Hlth, Dept Internal Med, Rochester, NY USA
[7] Univ Kentucky, Div Cardiol Gill Kentucky, Lexington, KY USA
[8] Univ Kentucky, Div Hosp Med, Lexington, KY 21229 USA
关键词
Bivalirudin; Heparin; Myocardial infarction; Percutaneous coronary intervention; ST-SEGMENT-ELEVATION; ELUTING STENTS; PRIMARY PCI; MONOTHERAPY; PLUS; MULTICENTER; GUIDELINES; MORTALITY; TIROFIBAN; RISK;
D O I
10.1016/j.carrev.2023.10.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Bivalirudin is an alternative accepted therapy to unfractionated heparin for patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). We aimed in this meta-analysis to compare bivalirudin versus unfractionated heparin in patients with MI undergoing PCI. Methods: We have screened PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov (inception through January 8th, 2023) for randomized controlled trials (RCTs) evaluating bivalirudin versus unfractionated heparin in patients with MI undergoing PCI. The DerSimonian and Laird method was used for estimation of tau2 to calculate the risk ratio (RR) and 95 % confidence interval (CI). Results: Ten RCTs with a total of 40,069 participants were included in our analysis. Bivalirudin as compared with unfractionated heparin was associated with significant decrease in major bleeding (RR 0.64 [0.52 to 0.79]; p < 0.01; I2 = 69 %) and cardiovascular mortality (RR 0.79 [0.67 to 0.92]; p < 0.01; I2 = 0 %). There was no significant difference between bivalirudin and unfractionated heparin groups in terms of major adverse cardiovascular events (RR 1.02 [0.91 to 1.14]; p = 0.73; I2 = 52 %), all-cause mortality (RR 0.89 [0.77 to 1.04]; p = 0.15; I2 = 23 %), MI (RR 1.02 [0.87 to 1.19]; p = 0.80; I2 = 36 %), stent thrombosis (RR 1.12 [0.52 to 2.40]; p = 0.77; I2 = 82 %), or stroke (RR 0.97 [0.73 to 1.29]; p = 0.85; I2 = 0 %). Conclusion: Our meta-analysis suggests that bivalirudin compared with unfractionated heparin in patients with MI undergoing PCI was associated with lower rates of major bleeding and cardiovascular mortality without a significant difference in major adverse cardiovascular events, all-cause mortality, MI, stroke, or stent thrombosis.
引用
收藏
页码:52 / 61
页数:10
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