This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (10) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Ebrahimi, R. Articles by Topol, E. J. Search for Related Content PubMed PubMed Citation Articles by Ebrahimi, R. Articles by Topol, E. J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Angioplasty Blood Thinners Hazardous Substances DB HEPARIN Social Bookmarking                         What's this?

Bivalirudin vs Heparin in Percutaneous Coronary Intervention: A Pooled Analysis

University of California, Los Angeles School of Medicine, West Los Angeles VA, Los Angeles, CA

A. Michael Lincoff, MD

Cleveland Clinic Foundation, Cleveland, OH

John A. Bittl, MD

Ocala Heart and Vascular Institute, Munroe Regional Medical Center, Ocala, FL

Derek Chew, MD

Flinders Medical Centre, Bedford Park, Australia

Kathy Wolski, MD

Cleveland Clinic Foundation, Cleveland, OH

Nitin Wadhan, MD

Cleveland Clinic Foundation, Cleveland, OH

Edward J. Toggart, MD

Cleveland Clinic Foundation, Cleveland, OH

Eric J. Topol, MD

Cleveland Clinic Foundation, Cleveland, OH

Objective: This study evaluates outcomes with bivalirudin vs heparin in various patient subgroups and the overall population during percutaneous coronary interventions (PCI). Background: Recent data suggest that bivalirudin, a reversible direct thrombin inhibitor, provides ischemic protection superior to heparin and comparable to heparin plus glycoprotein (GP) IIb/IIIa inhibitors but with significantly fewer bleeding complications. Whether this advantage persists in different subgroups has not been fully defined. To our knowledge, this is the largest pooled analysis of bivalirudin to date.

Methods: Four randomized controlled trials were identified that compared bivalirudin to heparin (with or without GP IIb/IIIa inhibitors) in PCI. The incidence of death, myocardial infarction (MI), revascularization, and major bleeding at 48 hours was compared between these two agents overall and in patients with and without diabetes mellitus, hypertension, renal insufficiency, and advanced age.

Results: The trials consisted of 11,638 patients (bivalirudin, 5,861; heparin, 5,777). There were no significant differences in patient characteristics between the two groups. At 48 hours, the incidence of death, MI, revascularization, and major bleeding was significantly reduced in the bivalirudin group (7.8% vs 1.08%, P < .001); individual ischemic end points were significantly reduced for death (0.01% vs 0.02%, P = .049) and revascularization (2.0% vs 2.7%, P = .02), with similar reductions for major bleeding (2.7% vs 5.8%, P < .001). Subgroup analysis was generally consistent with the overall findings.

Conclusion: This analysis further supports the superiority of bivalirudin compared with heparin. Bivalirudin provides excellent ischemic protection with a significant reduction of bleeding complications, even in high-risk subgroups.

Key Words: anticoagulation • percutaneous coronary intervention • bivalirudin

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 10, No. 4, 209-216 (2005)
DOI: 10.1177/107424840501000401


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [Abstract] [Full Text] [PDF]

				M. A. Crowther and T. E. Warkentin Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents Blood, May 15, 2008; 111(10): 4871 - 4879. [Abstract] [Full Text] [PDF]

				S. Singh, J. Molnar, and R. Arora Efficacy and Safety of Bivalirudin Versus Heparins in Reduction of Cardiac Outcomes in Acute Coronary Syndrome and Percutaneous Coronary Interventions Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2007; 12(4): 283 - 291. [Abstract] [PDF]

				I. J. Gudmundsdottir, I. L. Megson, J. S. Kell, C. A. Ludlam, K. A.A. Fox, D. J. Webb, and D. E. Newby Direct Vascular Effects of Protease-Activated Receptor Type 1 Agonism In Vivo in Humans Circulation, October 10, 2006; 114(15): 1625 - 1632. [Abstract] [Full Text] [PDF]