| Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty: A meta-analyis of randomised trials. | |
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MedLine Citation:
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PMID: 19718462 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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It has been shown that bleeding complications are associated with higher mortality rates among patients undergoing coronary angioplasty. Due to its properties, bivalirudin may provide benefits in terms of bleeding and thrombotic complications as compared to unfractionated heparin (UFH). The aim of the current study was to perform a meta-analysis of randomised trials to evaluate whether bivalirudin might offer benefits in terms of mortality as compared to UFH. We obtained results from all randomised trials evaluating the benefits of adjunctive bivalirudin as compared to UFH with or without Gp IIb-IIIa inhibitors among patients undergoing coronary angioplasty. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to October 2008. The following keywords were used: randomised trial, coronary angioplasty, stent, reperfusion, primary angioplasty, bivalirudin, direct thrombin inhibitors, hirulog. Primary endpoint was mortality. Secondary endpoint was infarction. Safety endpoint was the risk of major bleeding complications. No language restriction was applied. A total of nine randomised trials were included in the meta-analysis, with 15655 patients randomised to bivalirudin and 13104 patients randomised to UFH. We did not observe any difference in mortality between bivalirudin and UFH (1.73% vs 1.67%, p = 0.15) without any relationship between the baseline risk of mortality (r = 0.17, p = 0.71) or the reduction in major bleeding complications (r = -0.29, p = 0.53) and the benefits in mortality with bivalirudin. A trend in higher risk of myocardial infarction was observed with bivalirudin (6.9% vs 5.9%, p = 0.07, p het = 0.65). Bivalirudin was associated with a significant reduction in major bleeding complications (1.7% vs 3.4%, p < 0.0001), as compared to UFH. This meta-analysis shows that among patients undergoing coronary angioplasty, bivalirudin is associated with significant reduction in major bleeding complications. However, these benefits did not translate into benefits in mortality, with even a trend in higher risk of myocardial infarction. |
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Authors:
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Giuseppe De Luca; Ettore Cassetti; Monica Verdoia; Paolo Marino |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: Thrombosis and haemostasis Volume: 102 ISSN: 0340-6245 ISO Abbreviation: Thromb. Haemost. Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-08-31 Completed Date: 2009-11-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7608063 Medline TA: Thromb Haemost Country: Germany |
Other Details:
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Languages: eng Pagination: 428-36 Citation Subset: IM |
Affiliation:
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Chief Interventional Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University A. Avogadro, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty / methods* Anticoagulants / therapeutic use Heparin / therapeutic use* Hirudins Humans Middle Aged Myocardial Reperfusion Peptide Fragments / therapeutic use* Platelet Glycoprotein GPIIb-IIIa Complex / chemistry Randomized Controlled Trials as Topic Recombinant Proteins / therapeutic use Regression Analysis Stents Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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