Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Recent clinical trials have shown that while bivalirudin exhibits similar efficacy with heparin, it offers several advantages over heparin, such as a better safety profile. We aimed to evaluate the efficacy and safety of bivalirudin use during Percutaneous Coronary Intervention (PCI) in the treatmen...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-07-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fphar.2017.00410/full |
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| author | Abdul Hafeez Ahmad Hamdi Ahmad Fauzi Dali Thimarul Huda Mat Nuri Muhammad Syafiq Saleh Noor Nabila Ajmi Chin Fen Neoh Chin Fen Neoh Long Chiau Ming Long Chiau Ming Amir Heberd Abdullah Amir Heberd Abdullah Tahir Mehmood Khan |
| author_facet | Abdul Hafeez Ahmad Hamdi Ahmad Fauzi Dali Thimarul Huda Mat Nuri Muhammad Syafiq Saleh Noor Nabila Ajmi Chin Fen Neoh Chin Fen Neoh Long Chiau Ming Long Chiau Ming Amir Heberd Abdullah Amir Heberd Abdullah Tahir Mehmood Khan |
| author_sort | Abdul Hafeez Ahmad Hamdi |
| collection | DOAJ |
| description | Recent clinical trials have shown that while bivalirudin exhibits similar efficacy with heparin, it offers several advantages over heparin, such as a better safety profile. We aimed to evaluate the efficacy and safety of bivalirudin use during Percutaneous Coronary Intervention (PCI) in the treatment of angina and acute coronary syndrome (ACS). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, EMBASE, and Science Direct from January 1980 to January 2016. Randomized controlled trials (RCTs) comparing bivalirudin to heparin during the course of PCI in patients with angina or ACS were included. Outcome measures included all-cause mortality, myocardial infarction, revascularisation, stent thrombosis, stroke, and major bleeding. The selection, quality assessment, and data extraction of the included trials were done independently by four authors, and disagreements were resolved by consensus. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated. A total of 12 RCTs involving 44,088 subjects were included. Bivalirudin appeared to be non-superior compared to heparin in reducing all-cause mortality, myocardial infarction, revascularisation, and stroke. Bivalirudin appeared to be related to a higher risk of stent thrombosis when compared to heparin plus provisional use of a glycoprotein IIb/IIIa inhibitor (GPI) at day 30 (RR 1.94 [1.16, 3.24] p < 0.01). Overall, bivalirudin-based regimens present a lesser risk of major bleeding (RR 0.56 [0.44–0.71] p < 0.001), and Thrombolysis In Myocardial Infarction (TIMI) major bleeding (RR 0.56 [0.43–0.73]) compared with heparin-based regimens either with provisional or routine use of a GPI. However, the magnitude of TIMI major bleeding effect varied greatly (p < 0.001), depending on whether a GPI was provisionally used (RR 0.42 [0.34–0.52] p < 0.001) or routinely used (RR 0.60 [0.43 –0.83] p < 0.001), in the heparin arm. This meta-analysis demonstrated that bivalirudin is associated with a lower risk of major bleeding, but a higher risk of stent thrombosis compared to heparin. |
| first_indexed | 2024-12-20T15:19:46Z |
| format | Article |
| id | doaj.art-94393139f4ab49409f5db410128eb48b |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-20T15:19:46Z |
| publishDate | 2017-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-94393139f4ab49409f5db410128eb48b2022-12-21T19:36:05ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122017-07-01810.3389/fphar.2017.00410261514Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-AnalysisAbdul Hafeez Ahmad Hamdi0Ahmad Fauzi Dali1Thimarul Huda Mat Nuri2Muhammad Syafiq Saleh3Noor Nabila Ajmi4Chin Fen Neoh5Chin Fen Neoh6Long Chiau Ming7Long Chiau Ming8Amir Heberd Abdullah9Amir Heberd Abdullah10Tahir Mehmood Khan11Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaDepartment of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARAPuncak Alam, MalaysiaCollaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARAShah Alam, MalaysiaUnit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of TasmaniaHobart, TAS, AustraliaSchool of Pharmacy, KPJ Healthcare University CollegeNilai, MalaysiaVector-Borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARAShah Alam, MalaysiaFaculty of Health Sciences, Universiti Teknologi MARABertam, MalaysiaSchool of Pharmacy, Monash UniversitySunway, MalaysiaRecent clinical trials have shown that while bivalirudin exhibits similar efficacy with heparin, it offers several advantages over heparin, such as a better safety profile. We aimed to evaluate the efficacy and safety of bivalirudin use during Percutaneous Coronary Intervention (PCI) in the treatment of angina and acute coronary syndrome (ACS). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, EMBASE, and Science Direct from January 1980 to January 2016. Randomized controlled trials (RCTs) comparing bivalirudin to heparin during the course of PCI in patients with angina or ACS were included. Outcome measures included all-cause mortality, myocardial infarction, revascularisation, stent thrombosis, stroke, and major bleeding. The selection, quality assessment, and data extraction of the included trials were done independently by four authors, and disagreements were resolved by consensus. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated. A total of 12 RCTs involving 44,088 subjects were included. Bivalirudin appeared to be non-superior compared to heparin in reducing all-cause mortality, myocardial infarction, revascularisation, and stroke. Bivalirudin appeared to be related to a higher risk of stent thrombosis when compared to heparin plus provisional use of a glycoprotein IIb/IIIa inhibitor (GPI) at day 30 (RR 1.94 [1.16, 3.24] p < 0.01). Overall, bivalirudin-based regimens present a lesser risk of major bleeding (RR 0.56 [0.44–0.71] p < 0.001), and Thrombolysis In Myocardial Infarction (TIMI) major bleeding (RR 0.56 [0.43–0.73]) compared with heparin-based regimens either with provisional or routine use of a GPI. However, the magnitude of TIMI major bleeding effect varied greatly (p < 0.001), depending on whether a GPI was provisionally used (RR 0.42 [0.34–0.52] p < 0.001) or routinely used (RR 0.60 [0.43 –0.83] p < 0.001), in the heparin arm. This meta-analysis demonstrated that bivalirudin is associated with a lower risk of major bleeding, but a higher risk of stent thrombosis compared to heparin.http://journal.frontiersin.org/article/10.3389/fphar.2017.00410/fullacute coronary syndromeischemic eventsmyocardial infarctionstrokeglycoprotein IIb/IIIa inhibitormajor bleeding |
| spellingShingle | Abdul Hafeez Ahmad Hamdi Ahmad Fauzi Dali Thimarul Huda Mat Nuri Muhammad Syafiq Saleh Noor Nabila Ajmi Chin Fen Neoh Chin Fen Neoh Long Chiau Ming Long Chiau Ming Amir Heberd Abdullah Amir Heberd Abdullah Tahir Mehmood Khan Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis Frontiers in Pharmacology acute coronary syndrome ischemic events myocardial infarction stroke glycoprotein IIb/IIIa inhibitor major bleeding |
| title | Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis |
| title_full | Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis |
| title_fullStr | Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis |
| title_short | Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis |
| title_sort | safety and effectiveness of bivalirudin in patients undergoing percutaneous coronary intervention a systematic review and meta analysis |
| topic | acute coronary syndrome ischemic events myocardial infarction stroke glycoprotein IIb/IIIa inhibitor major bleeding |
| url | http://journal.frontiersin.org/article/10.3389/fphar.2017.00410/full |
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