Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis
BackgroundThe optimal antithrombotic therapy in patients with ST‐segment‐elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) remains a matter of debate. This updated meta‐analysis investigated the impact of (1) bivalirudin (with and without prolonged infusion)...
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| Format: | Article |
| Language: | English |
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Wiley
2016-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003515 |
| _version_ | 1818393489805672448 |
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| author | Gregor Fahrni Mathias Wolfrum Giovanni Luigi De Maria Adrian P. Banning Umberto Benedetto Rajesh K. Kharbanda |
| author_facet | Gregor Fahrni Mathias Wolfrum Giovanni Luigi De Maria Adrian P. Banning Umberto Benedetto Rajesh K. Kharbanda |
| author_sort | Gregor Fahrni |
| collection | DOAJ |
| description | BackgroundThe optimal antithrombotic therapy in patients with ST‐segment‐elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) remains a matter of debate. This updated meta‐analysis investigated the impact of (1) bivalirudin (with and without prolonged infusion) and (2) prolonged PCI‐dose (1.75 mg/hg per hour) bivalirudin infusion compared with conventional antithrombotic therapy on clinical outcomes in patients undergoing primary PCI. Methods and ResultsEligible randomized trials were searched through MEDLINE, EMBASE, Cochrane database, and proceedings of major congresses. Prespecified outcomes were major bleeding (thrombolysis in myocardial infarction major and Bleeding Academic Research Consortium 3–5), acute stent thrombosis, as well as all‐cause and cardiac mortality at 30 days. Six randomized trials (n=17 294) were included. Bivalirudin compared with heparin (+/− glycoprotein‐IIb/IIIa inhibitor) was associated with reduction in major bleeding (odds ratio [OR]: 0.65, 95% CI: 0.48–0.88, P=0.006, derived from all 6 trials), increase in acute stent thrombosis (OR: 2.75, 95% CI: 1.46–5.18, P=0.002, 5 trials), and lower rate of all‐cause mortality (OR: 0.81, 95% CI: 0.67–0.98, P=0.03, 6 trials) as well as cardiac mortality (OR: 0.69, 95% CI: 0.55–0.87, P=0.001, 5 trials). The incidence of acute stent thrombosis did not differ between the prolonged PCI‐dose bivalirudin and comparator group (OR: 0.81, 95% CI: 0.27–2.46, P=0.71, 3 trials), whereas the risk of bleeding was reduced despite treatment with high‐dose bivalirudin infusion (OR: 0.28, 95% CI: 0.13–0.60, P=0.001, 3 trials). ConclusionsBivalirudin (with and without prolonged infusion) compared with conventional antithrombotic therapy in ST‐segment‐elevation myocardial infarction patients undergoing primary PCI reduces major bleeding and death, but increases the rate of acute stent thrombosis. However, prolonging the bivalirudin infusion at PCI‐dose (1.75 mg/kg per hour) for 3 hours eliminates the excess risk of acute stent thrombosis, while maintaining the bleeding benefits. |
| first_indexed | 2024-12-14T05:46:08Z |
| format | Article |
| id | doaj.art-d72fd4fd23d24f0f9687b1832368cd85 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T05:46:08Z |
| publishDate | 2016-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d72fd4fd23d24f0f9687b1832368cd852022-12-21T23:14:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-07-015710.1161/JAHA.116.003515Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐AnalysisGregor Fahrni0Mathias Wolfrum1Giovanni Luigi De Maria2Adrian P. Banning3Umberto Benedetto4Rajesh K. Kharbanda5Oxford Heart Centre, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UKOxford Heart Centre, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UKOxford Heart Centre, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UKOxford Heart Centre, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UKBristol Heart Institute, School of Clinical Sciences, University of Bristol, UKOxford Heart Centre, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UKBackgroundThe optimal antithrombotic therapy in patients with ST‐segment‐elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) remains a matter of debate. This updated meta‐analysis investigated the impact of (1) bivalirudin (with and without prolonged infusion) and (2) prolonged PCI‐dose (1.75 mg/hg per hour) bivalirudin infusion compared with conventional antithrombotic therapy on clinical outcomes in patients undergoing primary PCI. Methods and ResultsEligible randomized trials were searched through MEDLINE, EMBASE, Cochrane database, and proceedings of major congresses. Prespecified outcomes were major bleeding (thrombolysis in myocardial infarction major and Bleeding Academic Research Consortium 3–5), acute stent thrombosis, as well as all‐cause and cardiac mortality at 30 days. Six randomized trials (n=17 294) were included. Bivalirudin compared with heparin (+/− glycoprotein‐IIb/IIIa inhibitor) was associated with reduction in major bleeding (odds ratio [OR]: 0.65, 95% CI: 0.48–0.88, P=0.006, derived from all 6 trials), increase in acute stent thrombosis (OR: 2.75, 95% CI: 1.46–5.18, P=0.002, 5 trials), and lower rate of all‐cause mortality (OR: 0.81, 95% CI: 0.67–0.98, P=0.03, 6 trials) as well as cardiac mortality (OR: 0.69, 95% CI: 0.55–0.87, P=0.001, 5 trials). The incidence of acute stent thrombosis did not differ between the prolonged PCI‐dose bivalirudin and comparator group (OR: 0.81, 95% CI: 0.27–2.46, P=0.71, 3 trials), whereas the risk of bleeding was reduced despite treatment with high‐dose bivalirudin infusion (OR: 0.28, 95% CI: 0.13–0.60, P=0.001, 3 trials). ConclusionsBivalirudin (with and without prolonged infusion) compared with conventional antithrombotic therapy in ST‐segment‐elevation myocardial infarction patients undergoing primary PCI reduces major bleeding and death, but increases the rate of acute stent thrombosis. However, prolonging the bivalirudin infusion at PCI‐dose (1.75 mg/kg per hour) for 3 hours eliminates the excess risk of acute stent thrombosis, while maintaining the bleeding benefits.https://www.ahajournals.org/doi/10.1161/JAHA.116.003515bivalirudinmeta‐analysismyocardial infarctionpercutaneous coronary intervention |
| spellingShingle | Gregor Fahrni Mathias Wolfrum Giovanni Luigi De Maria Adrian P. Banning Umberto Benedetto Rajesh K. Kharbanda Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bivalirudin meta‐analysis myocardial infarction percutaneous coronary intervention |
| title | Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis |
| title_full | Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis |
| title_fullStr | Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis |
| title_full_unstemmed | Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis |
| title_short | Prolonged High‐Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta‐Analysis |
| title_sort | prolonged high dose bivalirudin infusion reduces major bleeding without increasing stent thrombosis in patients undergoing primary percutaneous coronary intervention novel insights from an updated meta analysis |
| topic | bivalirudin meta‐analysis myocardial infarction percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003515 |
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