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Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis.

Kinnaird T, Medic G, Casella G, Schiele F, Kaul U, Radke PW, Eijgelshoven I, Bergman G, Chew DP - J Blood Med (2013)

Bottom Line: At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37-2.13), myocardial infarction (OR, 0.79; CrL, 0.40-1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45-0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy.For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy.This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

View Article: PubMed Central - PubMed

Affiliation: Cardiff and Vale University Health Board, Cardiff, UK.

ABSTRACT
In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32-0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37-2.13), myocardial infarction (OR, 0.79; CrL, 0.40-1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45-0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the selected studies.Abbreviations: MEIP, Medline in Progress; CCTR, Cochrane Controlled Trials Registry.
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f1-jbm-4-129: Flow chart of the selected studies.Abbreviations: MEIP, Medline in Progress; CCTR, Cochrane Controlled Trials Registry.

Mentions: The systematic literature review identified 841 potentially relevant abstracts, of which 719 were excluded on the basis of their abstracts (Figure 1). Of the remaining 122 studies, 109 publications were excluded after a full text review, resulting in 13 relevant identified publications. Two full-text publications21,22 mentioned in the De Luca et al 200923 meta-analysis were of interest and were not retrieved by the systematic literature search. These publications were manually added to the 13 systematically identified articles. In total, 15 publications were included, covering eight individual studies including a total of 8,807 adult patients.


Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis.

Kinnaird T, Medic G, Casella G, Schiele F, Kaul U, Radke PW, Eijgelshoven I, Bergman G, Chew DP - J Blood Med (2013)

Flow chart of the selected studies.Abbreviations: MEIP, Medline in Progress; CCTR, Cochrane Controlled Trials Registry.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3794970&req=5

f1-jbm-4-129: Flow chart of the selected studies.Abbreviations: MEIP, Medline in Progress; CCTR, Cochrane Controlled Trials Registry.
Mentions: The systematic literature review identified 841 potentially relevant abstracts, of which 719 were excluded on the basis of their abstracts (Figure 1). Of the remaining 122 studies, 109 publications were excluded after a full text review, resulting in 13 relevant identified publications. Two full-text publications21,22 mentioned in the De Luca et al 200923 meta-analysis were of interest and were not retrieved by the systematic literature search. These publications were manually added to the 13 systematically identified articles. In total, 15 publications were included, covering eight individual studies including a total of 8,807 adult patients.

Bottom Line: At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37-2.13), myocardial infarction (OR, 0.79; CrL, 0.40-1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45-0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy.For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy.This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

View Article: PubMed Central - PubMed

Affiliation: Cardiff and Vale University Health Board, Cardiff, UK.

ABSTRACT
In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32-0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37-2.13), myocardial infarction (OR, 0.79; CrL, 0.40-1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45-0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.

No MeSH data available.


Related in: MedlinePlus