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
Tim Kinnaird,1 Goran Medic,2 Gianni Casella,3 Francois Schiele,4 Upendra Kaul,5 Peter W Radke,6 Indra Eijgelshoven,2 Gert Bergman,2 Derek P Chew71Cardiff and Vale University Health Board, Cardiff, UK; 2Mapi-Health Economics Outcomes Research and Strategic Market Access, Houten, the Netherlands; 3Osp...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2013-10-01
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| Series: | Journal of Blood Medicine |
| Online Access: | http://www.dovepress.com/relative-efficacy-of-bivalirudin-versus-heparin-monotherapy-in-patient-a14550 |
| _version_ | 1811215125318729728 |
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| author | Kinnaird T Medic G Casella G Schiele F Kaul U Radke PW Eijgelshoven I Bergman G Chew DP |
| author_facet | Kinnaird T Medic G Casella G Schiele F Kaul U Radke PW Eijgelshoven I Bergman G Chew DP |
| author_sort | Kinnaird T |
| collection | DOAJ |
| description | Tim Kinnaird,1 Goran Medic,2 Gianni Casella,3 Francois Schiele,4 Upendra Kaul,5 Peter W Radke,6 Indra Eijgelshoven,2 Gert Bergman,2 Derek P Chew71Cardiff and Vale University Health Board, Cardiff, UK; 2Mapi-Health Economics Outcomes Research and Strategic Market Access, Houten, the Netherlands; 3Ospedale Maggiore, Unità Operativa di Cardiologia, Bologna, Italy; 4Hôpital Jean Minjoz, Besançon Cedex, France; 5Fortis Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India; 6Schön Klinik Neustadt, Neustadt, Germany; 7Flinders University; Department of Cardiovascular Medicine, Southern Adelaide Health Service, Bedford Park, SA, AustraliaAbstract: 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.Keywords: primary angioplasty, STEMI, pharmacology |
| first_indexed | 2024-04-12T06:16:09Z |
| format | Article |
| id | doaj.art-85f03d51a9fc415e8781fd4a30781027 |
| institution | Directory Open Access Journal |
| issn | 1179-2736 |
| language | English |
| last_indexed | 2024-04-12T06:16:09Z |
| publishDate | 2013-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Blood Medicine |
| spelling | doaj.art-85f03d51a9fc415e8781fd4a307810272022-12-22T03:44:29ZengDove Medical PressJournal of Blood Medicine1179-27362013-10-012013default129140Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysisKinnaird TMedic GCasella GSchiele FKaul URadke PWEijgelshoven IBergman GChew DPTim Kinnaird,1 Goran Medic,2 Gianni Casella,3 Francois Schiele,4 Upendra Kaul,5 Peter W Radke,6 Indra Eijgelshoven,2 Gert Bergman,2 Derek P Chew71Cardiff and Vale University Health Board, Cardiff, UK; 2Mapi-Health Economics Outcomes Research and Strategic Market Access, Houten, the Netherlands; 3Ospedale Maggiore, Unità Operativa di Cardiologia, Bologna, Italy; 4Hôpital Jean Minjoz, Besançon Cedex, France; 5Fortis Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India; 6Schön Klinik Neustadt, Neustadt, Germany; 7Flinders University; Department of Cardiovascular Medicine, Southern Adelaide Health Service, Bedford Park, SA, AustraliaAbstract: 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.Keywords: primary angioplasty, STEMI, pharmacologyhttp://www.dovepress.com/relative-efficacy-of-bivalirudin-versus-heparin-monotherapy-in-patient-a14550 |
| spellingShingle | Kinnaird T Medic G Casella G Schiele F Kaul U Radke PW Eijgelshoven I Bergman G Chew DP 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 Journal of Blood Medicine |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://www.dovepress.com/relative-efficacy-of-bivalirudin-versus-heparin-monotherapy-in-patient-a14550 |
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