Purpose: Benefit of bivalirudin for patients undergoing percutaneous coronary intervention has been demonstrated over heparin, although still not conclusive evidence has been provided about interaction between anticoagulation and site of access. Methods: All studies investigating patients undergoing radial or femoral PCI and comparing bivalirudin and heparin (with or without GPI) were included in the present review. Major bleeding was the primary end point, with death, MACE (a composite end point of death, myocardial infarction and target vessel revascularization) and NACE (Net Adverse Clinical Events) the secondary ones. Results: 6 studies with 521638 patients were included. Median age was 63 years old (61-65); 26% (24-28) of the patients were female, 21% (17-32) had diabetes mellitus and 17% (12- 21) renal disease. During hospitalization, bivalirudin reduced risk of bleeding, both for patients with femoral (OR 0.73 [0.60, 0.90]) and radial (OR 0.51 [0.43, 0.60]) access. Death and MACE rates, on the contrary, were not reduced by bivalirudin, both for radial (OR 0.86 [0.69, 1.07] and 0.86 [0.53, 1.39] respectively) and for femoral (OR 1.07 [0.74, 1.56] and 0.24 [0.04, 1.59] respectively). Similarly, rates of NACE did not differ in the two groups (0.87 [0.38, 1.96] and 0.70 [0.49, 0.98], all CI 95%). Conclusions: Benefit of bivalirudin for reduction of bleeding is consistent both for radial and for femoral access.
Role of bivalirudin in radial coronary interventions: a meta-analysis of observational studies
D'ASCENZO, FABRIZIO;PELLONI, ELISA;GAITA, Fiorenzo;
2014-01-01
Abstract
Purpose: Benefit of bivalirudin for patients undergoing percutaneous coronary intervention has been demonstrated over heparin, although still not conclusive evidence has been provided about interaction between anticoagulation and site of access. Methods: All studies investigating patients undergoing radial or femoral PCI and comparing bivalirudin and heparin (with or without GPI) were included in the present review. Major bleeding was the primary end point, with death, MACE (a composite end point of death, myocardial infarction and target vessel revascularization) and NACE (Net Adverse Clinical Events) the secondary ones. Results: 6 studies with 521638 patients were included. Median age was 63 years old (61-65); 26% (24-28) of the patients were female, 21% (17-32) had diabetes mellitus and 17% (12- 21) renal disease. During hospitalization, bivalirudin reduced risk of bleeding, both for patients with femoral (OR 0.73 [0.60, 0.90]) and radial (OR 0.51 [0.43, 0.60]) access. Death and MACE rates, on the contrary, were not reduced by bivalirudin, both for radial (OR 0.86 [0.69, 1.07] and 0.86 [0.53, 1.39] respectively) and for femoral (OR 1.07 [0.74, 1.56] and 0.24 [0.04, 1.59] respectively). Similarly, rates of NACE did not differ in the two groups (0.87 [0.38, 1.96] and 0.70 [0.49, 0.98], all CI 95%). Conclusions: Benefit of bivalirudin for reduction of bleeding is consistent both for radial and for femoral access.
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