Key result
Bivalirudin use during percutaneous peripheral interventions was associated with lower all-cause mortality (RR 0.58; 95% CI 0.39-0.87) and bleeding compared to heparin.
Why the study?
Bivalirudin may be an effective alternative anticoagulant to heparin in percutaneous peripheral interventions, but its comparative safety and efficacy required evaluation.
Does bivalirudin reduce mortality and bleeding compared to heparin in patients undergoing percutaneous peripheral interventions?
Meta-Analysis (n=20,137)
Does bivalirudin reduce mortality and bleeding compared to heparin in patients undergoing percutaneous peripheral interventions?
In patients undergoing percutaneous peripheral interventions, bivalirudin as a procedural anticoagulant is associated with lower mortality and bleeding compared to heparin.
May favor bivalirudin over heparin in percutaneous peripheral interventions; extends pooled evidence but requires RCT confirmation.
BACKGROUND: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. METHODS: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. RESULTS: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39-0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50-0.78), major bleeding (risk ratio 0.61, 95% CI 0.39-0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47-0.92), and access site complications (risk ratio 0.66, 95% CI 0.51-0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57-1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59-1.28), stroke (risk ratio 0.77, 95% CI 0.59-1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29-2.02), or amputations (OR 0.75, 95% CI 0.53-1.05). CONCLUSION: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.
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Olmedo et al. (2018) conducted a meta-analysis in Patients undergoing percutaneous peripheral interventions (n=20,137). Bivalirudin vs. Heparin was evaluated on All-cause mortality (RR 0.58, 95% CI 0.39-0.87). Bivalirudin use during percutaneous peripheral interventions was associated with lower all-cause mortality (RR 0.58; 95% CI 0.39-0.87) and bleeding compared to heparin.
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