Key result
Bivalirudin plus glycoprotein IIb/IIIa inhibitors resulted in a similar incidence of major adverse cardiac events compared to heparin plus glycoprotein IIb/IIIa inhibitors (RR 1.06), though provisional use significantly reduced major bleeding.
Why the study?
A variety of antithrombotic drugs are used during PCI, and the study aimed to investigate the practicability of using bivalirudin and GPIs in patients receiving PCI.
Does bivalirudin plus planned or provisional glycoprotein IIb/IIIa inhibitors reduce major adverse cardiac events or bleeding compared to heparin plus glycoprotein IIb/IIIa inhibitors or bivalirudin monotherapy in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=17,490)
Does bivalirudin plus planned or provisional glycoprotein IIb/IIIa inhibitors reduce major adverse cardiac events or bleeding compared to heparin plus glycoprotein IIb/IIIa inhibitors or bivalirudin monotherapy in patients undergoing percutaneous coronary intervention?
In patients undergoing PCI, bivalirudin plus provisional GPI provides similar efficacy to heparin plus GPI but significantly reduces the risk of major bleeding, whereas bivalirudin monotherapy remains the safest option regarding bleeding risk.
Supports bivalirudin plus provisional GPI over heparin plus GPI in PCI to reduce bleeding without increased MACE; extends meta-analytic confirmation of bleeding-avoidance strategies.
A variety of antithrombotic drugs are used during percutaneous coronary interventions (PCIs). We aimed to investigate the practicability of the use of bivalirudin and GPIs in patients receiving PCI. We searched 7 of 629 relevant records from PubMed, the Cochrane Library, EMBASE, and Web of Science for randomised controlled trials. There were no significant differences in the rates of major adverse cardiac events (MACE) between bivalirudin plus GPI and heparin (all P > .05). Bivalirudin plus planned GPI was similar to bivalirudin monotherapy in terms of the risk of MACE (risk ratio [RR] = 1.07; 95% confidence interval [CI] = .91 − 1.27; P = .55). Bivalirudin plus provisional GPI was associated with lower bleeding risk (RR = .57; 95% CI = .47 − .69; P < .01) compared to using heparin plus GPI. Compared to bivalirudin alone, bivalirudin plus planned GPI evidently increased bleeding risk (RR = 2.20; 95% CI = 1.73 − 2.79; P < .01). Patients receiving bivalirudin or heparin therapy had semblable efficacy endpoints, but those receiving bivalirudin had a significantly lower bleeding risk. For high-risk bleeding patients, bivalirudin plus provisional GPI can have a better antithrombotic effect than heparin, without increasing the bleeding risk.
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Li et al. (2021) conducted a meta-analysis in Percutaneous coronary intervention (n=17,490). Bivalirudin plus glycoprotein IIb/IIIa inhibitors vs. Heparin plus glycoprotein IIb/IIIa inhibitors was evaluated on Major adverse cardiac events (MACE) within 30 days (RR 1.06, 95% CI 0.95-1.18, p=0.27). Bivalirudin plus glycoprotein IIb/IIIa inhibitors resulted in a similar incidence of major adverse cardiac events compared to heparin plus glycoprotein IIb/IIIa inhibitors (RR 1.06), though provisional use significantly reduced major bleeding.
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