BIVALIRUDIN VERSUS HEPARIN IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROMES
Recommended Citation
Qadeer YK, Krittanawong C, Wang Z, Ahuja T, Alam M, Jneid H. BIVALIRUDIN VERSUS HEPARIN IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROMES. J Am Coll Cardiol 2025; 85(12):949.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
bivalirudin, heparin, acute coronary syndrome, all cause mortality, anticoagulation, cardiovascular disease, cerebrovascular accident, complication, conference abstract, human, major adverse cardiac event, major bleeding, major clinical study, meta analysis, meta analysis (topic), percutaneous coronary intervention, stent thrombosis, systematic review, target vessel revascularization, therapy, thrombocytopenia
Abstract
Background: Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS) remains inconclusive. We aimed to systematically analyze PCI outcomes comparing unfractionated heparin and bivalirudin. Methods We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed data. Conflicts were resolved through consensus. Random-effects metaanalyses were used. Results Ten prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding (RR 1.68, 95% CI 1.29-2.20), non-access site complications (RR 4.6, 95% CI 1.75-12.09), TIMI major bleeding (RR 1.70, 95% CI 1.202.41), major bleeding risks (RR 1.87, 95% CI 1.49-2.36), cardiovascular disease death (RR 1.26, 95% CI 1.02-1.57), and thrombocytopenia (RR 1.67, 95% CI 1.07-2.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, MACE (RR 1.05, 95% CI .94-1.17), stroke, reinfarction, target vessel revascularization, acute or stent thrombosis (RR .81, 95% CI .42- 1.56). Conclusion Our data demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiac events.
Volume
85
Issue
12
First Page
949
