Heparin is Not Inferior to Bivalirudin in Percutaneous Coronary Intervention-Focusing on the Effect of Glycoprotein IIb/IIIa Inhibitor Use: A Meta-Analysis.
Our aim was to compare the efficacy and safety of bivalirudin (Biv) versus heparin (Hep) with or without similar usage rate of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI). The PubMed and EMbase were searched. Randomized trials comparing Biv versus Hep were eligible for inclusion. With imbalanced GPI use, Biv had significantly lower major bleeding (pooled risk ratio [RR], 0.67; 95% confidence interval [CI], 0.54-0.83) without difference in mortality (pooled RR, 0.95; 95% CI, 0.80-1.14). With comparable GPI use, no significant difference was observed in major bleeding (pooled RR, 0.95; 95% CI, 0.82-1.10) and mortality (pooled RR, 1.13; 95% CI, 0.85-1.50). With no GPI use, Biv was associated with numerically higher mortality (pooled RR, 1.17; 95% CI, 0.83-1.65) without significant difference in major bleeding (pooled RR, 0.81; 95% CI, 0.64-1.02). In conclusion, when comparing different anticoagulants during PCI, the effect of GPIs should not be underestimated. Heparin as such was found noninferior to Biv.
['Huang|Fang-Yang|FY|', 'Huang|Bao-Tao|BT|', 'Peng|Yong|Y|', 'Liu|Wei|W|', 'Zhao|Zhen-Gang|ZG|', 'Wang|Peng-Ju|PJ|', 'Zuo|Zhi-Liang|ZL|', 'Zhang|Chen|C|', 'Liao|Yan-Biao|YB|', 'Luo|Xiao-Lin|XL|', 'Meng|Qing-Tao|QT|', 'Chen|Chi|C|', 'Huang|Kai-Sen|KS|', 'Chai|Hua|H|', 'Li|Qiao|Q|', 'Chen|Mao|M|', 'Zhu|Ye|Y|']
D000925:Anticoagulants D000991:Antithrombins D016009:Chi-Square Distribution D003328:Coronary Thrombosis D006470:Hemorrhage D006493:Heparin D006629:Hirudins D006801:Humans D016017:Odds Ratio D010446:Peptide Fragments D062645:Percutaneous Coronary Intervention D010975:Platelet Aggregation Inhibitors D019039:Platelet Glycoprotein GPIIb-IIIa Complex D011994:Recombinant Proteins D018570:Risk Assessment D012307:Risk Factors D016896:Treatment Outcome
heparin bivalirudin glycoprotein IIb/IIIa inhibitor percutaneous coronary intervention