C-38 | Impact of Bivalirudin Versus Heparin on Major Bleeding During Percutaneous Coronary Interventions (PCI): An Updated Meta-Analysis of Randomized Controlled Trials (RCTs)

Bivalirudin gained ground against heparin in PCI due to fewer bleeding risks; however, other safety outcomes are still debatable. We aim to compare such outcomes of bivalirudin and heparin in patients undergoing PCI for ACS. We conducted a meta-analysis of the RCTs that randomized patients with myocardial infarction undergoing PCI to bivalirudin or heparin and assessed several safety outcomes. Primary endpoint was thirty-day major bleeding and secondary endpoints were thirty-day all-cause mortality, cardiovascular death (CVD), stent thrombosis, reinfarction, stroke and target vessel revascularization (TVR). A total of 41,374 patients were randomized: 20,139 to bivalirudin and 21,235 to heparin. Thirty-day major bleeding was lower in the bivalirudin group when compared with heparin (RR 0.63, 95% CI: 0.50 - 0.79; p < .0001). Similarly, thirty-day CVD was lower in bivalirudin group compared to heparin (RR 0.80, 95% CI: 0.68 - 0.94; p < .006). Such differences between the groups were not observed in thirty-day all-cause mortality (p =.09), stroke (p =.36), stent thrombosis (p =.75), reinfarction (p =.39), and TVR (p =.18). Using the totality of the data available to date, procedural anticoagulation with bivalirudin reduced major bleeding and cardiovascular death when compared with heparin in patients undergoing PCI. Such statistically significant differences were not observed between the groups when examined all-cause mortality, stroke, stent thrombosis, reinfarction, and TVR. Bivalirudin should be considered as the first line anticoagulation method in patients undergoing PCI that are at high-risk for bleeding.