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Bivalirudin versus unfractionated heparin in patients with myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomized controlled trials.
Al-Abdouh, Ahmad; Mhanna, Mohammed; Jabri, Ahmad; Madanat, Luai; Alhuneafat, Laith; Mostafa, Mostafa Reda; Kundu, Amartya; Gupta, Vedant.
Afiliación
  • Al-Abdouh A; Department of Medicine, University of Kentucky, KY, USA. Electronic address: ahmad.al-abdouh@uky.edu.
  • Mhanna M; Department of Cardiovascular Medicine, University of Iowa, IA, USA.
  • Jabri A; Department of Cardiology, Case Western University (Metrohealth), Cleveland, OH, USA.
  • Madanat L; Department of Medicine, Beaumont Hospital, Detroid, MI, USA.
  • Alhuneafat L; Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
  • Mostafa MR; Department of Internal Medicine, Rochester Regional Health, Rochester, NY, USA.
  • Kundu A; Division of Cardiology (Gill Kentucky), University of Kentucky, Lexington, KY, USA.
  • Gupta V; Division of Cardiology (Gill Kentucky), University of Kentucky, Lexington, KY, USA.
Cardiovasc Revasc Med ; 61: 52-61, 2024 Apr.
Article en En | MEDLINE | ID: mdl-37872022
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis / Accidente Cerebrovascular / Intervención Coronaria Percutánea / Infarto del Miocardio Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: Cardiovasc Revasc Med Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis / Accidente Cerebrovascular / Intervención Coronaria Percutánea / Infarto del Miocardio Tipo de estudio: Systematic_reviews Límite: Humans Idioma: En Revista: Cardiovasc Revasc Med Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos