Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 148(16), 1207–1219. https://doi.org/10.1161/CIRCULATIONAHA.123.063946 Dr. Behnood Bikdeli et al.
Points
- A study compared bivalirudin and heparin as anticoagulation strategies in non-ST-segment-elevation myocardial infarction patients undergoing percutaneous coronary intervention (PCI).
- The analysis included data from over 12,000 patients in five trials and found no significant difference in 30-day all-cause mortality, cardiac mortality, reinfarction, or stent thrombosis between bivalirudin and heparin.
- Compared to heparin, Bivalirudin demonstrated a notable advantage by reducing serious bleeding at access and non-access sites.
- The outcomes remained consistent whether a post-PCI bivalirudin infusion or routine glycoprotein IIb/IIIa inhibitors were employed with heparin.
- The study’s conclusion highlights the comparable efficacy of bivalirudin and heparin in this patient population, with the added benefit of reduced serious bleeding associated with bivalirudin.
Summary
The choice between bivalirudin and heparin as anticoagulants has remained uncertain in the realm of percutaneous coronary intervention (PCI) for patients with non-ST-segment-elevation myocardial infarction. While existing study-level meta-analyses have sought to address this issue, their limited granularity has prevented conclusive answers. Therefore, a team of researchers embarked on an individual patient data meta-analysis, combining data from five distinct trials involving over 12,000 patients. Their primary objectives were to compare the effectiveness and safety of bivalirudin versus heparin in this patient population.
The meta-analysis encompassed 12,155 patients, 52.3% receiving bivalirudin and 53.2% receiving heparin. The analysis found that the 30-day all-cause mortality rates were not significantly different between the two anticoagulation strategies (1.2% for bivalirudin versus 1.1% for heparin). Likewise, cardiac mortality, reinfarction, and stent thrombosis rates did not show statistically significant differences. Notably, bivalirudin exhibited a distinct advantage in reducing serious bleeding related to access and non-access sites (3.3% for bivalirudin versus 5.5% for heparin).
The study’s conclusions emphasize that in the context of non-ST-segment-elevation myocardial infarction patients undergoing PCI, there was no significant disparity in mortality rates or ischemic events between those receiving bivalirudin and heparin. Furthermore, bivalirudin’s administration yielded a marked reduction in serious bleeding, whether associated with the access site or at non-access sites. These findings were consistent regardless of whether a post-PCI bivalirudin infusion or routine glycoprotein IIb/IIIa inhibitors were employed in conjunction with heparin.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24076
References Bikdeli, B., Erlinge, D., Valgimigli, M., Kastrati, A., Han, Y., Steg, P. G., Stables, R. H., Mehran, R., James, S. K., Frigoli, E., Goldstein, P., Li, Y., Shahzad, A., Schüpke, S., Mehdipoor, G., Chen, S., Redfors, B., Crowley, A., Zhou, Z., & Stone, G. W. (2023). Bivalirudin versus heparin during pci in nstemi: Individual patient data meta-analysis of large randomized trials. Circulation, 148(16), 1207–1219. https://doi.org/10.1161/CIRCULATIONAHA.123.063946
