TY - JOUR
T1 - Bivalirudin versus unfractionated heparin in peripheral vascular interventions
AU - Omran, Jad
AU - Enezate, Tariq
AU - Abdullah, Obai
AU - Al-Dadah, Ashraf S.
AU - Aronow, Herbert D.
AU - Mustapha, Jihad
AU - Saab, Fadi
AU - Brilakis, Emmanouil S.
AU - Reeves, Ryan R.
AU - Bhatt, Deepak L.
AU - Mahmud, Ehtisham
N1 - Funding Information:
1- Jad Omran MD: None. 2- Tariq Enezate MD: None. 3- Obai Abdullah MD: None. 4- Ashraf Al-Dadah MD: None. 5- Herbert D. Aronow MD MPH: None. 6- Jihad Mustapha MD: None. 7- Fadi Saab MD: None. 8- Emmanouil S Brilakis MD PHD: consulting/speaker honoraria from Abbott Vascular, Amgen, Asahi, CSI, Elsevier, GE Healthcare, and Medicure; research support from Boston Scientific and Osprey; spouse was employee of Medtronic. 9- Ryan Reeves MD: None. 10- Ehtisham Mahmud MD: None. 11- Deepak L.Bhatt MD MPH: Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org ), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. The following are the supplementary data related to this article. Supplemental Table 1 Risk of bias assessment for observational (prospective and retrospective) studies. Supplemental Table 1 Supplemental Fig. 1 PRISMA data flow chart shows the results of the primary search and selection process of the studies that met inclusion criteria. Supplemental Fig. 1 Supplemental Fig. 2 Funnel plot of standard error by log odd ratio, which shows symmetrical study distribution around the vertical line indicating low risk publication bias. Supplemental Fig. 2 Supplementary data to this article can be found online at https://doi.org/10.1016/j.carrev.2018.01.010 .
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Background: A number of studies suggest that bivalirudin (BIV) is associated with similar efficacy but reduced bleeding when compared with unfractionated heparin (UFH) in patients undergoing peripheral vascular interventions (PVI). Methods: A comprehensive literature search was conducted with the electronic databases MEDLINE, EMBASE and CENTRAL. These were queried to identify studies comparing BIV with UFH in PVI. Study endpoints included total bleeding events, major and minor bleeding events and procedural success. Random-effects meta-analysis method was used to pool endpoint odds ratios (OR) for both UFH and BIV with 95% confidence intervals (CI). Results: A total of 12,335 patients (70.6 years; 59.7% male) were included from seven observational cohort studies (two prospective and five retrospective) comparing outcomes between BIV and UFH during PVI between January 2000 and May 2017. Compared with BIV, UFH was associated with significantly higher total bleeding, (OR 1.52 with 95% CI 1.11 to 2.09, p = 0.009), major bleeding (OR 1.38 with 95% CI 1.13 to 1.68, p = 0.002), and minor bleeding (OR 1.51 with 95% CI 1.09 to 2.08, p = 0.01). Procedural success rates were not different between the two groups (BIV vs HEP: OR 0.90 with 95% CI 0.49 to 1.64, p = 0.72) Conclusion: Compared with BIV, UFH was associated with more bleeding when used during PVI. There was no significant difference in procedural success between the two anticoagulation strategies.
AB - Background: A number of studies suggest that bivalirudin (BIV) is associated with similar efficacy but reduced bleeding when compared with unfractionated heparin (UFH) in patients undergoing peripheral vascular interventions (PVI). Methods: A comprehensive literature search was conducted with the electronic databases MEDLINE, EMBASE and CENTRAL. These were queried to identify studies comparing BIV with UFH in PVI. Study endpoints included total bleeding events, major and minor bleeding events and procedural success. Random-effects meta-analysis method was used to pool endpoint odds ratios (OR) for both UFH and BIV with 95% confidence intervals (CI). Results: A total of 12,335 patients (70.6 years; 59.7% male) were included from seven observational cohort studies (two prospective and five retrospective) comparing outcomes between BIV and UFH during PVI between January 2000 and May 2017. Compared with BIV, UFH was associated with significantly higher total bleeding, (OR 1.52 with 95% CI 1.11 to 2.09, p = 0.009), major bleeding (OR 1.38 with 95% CI 1.13 to 1.68, p = 0.002), and minor bleeding (OR 1.51 with 95% CI 1.09 to 2.08, p = 0.01). Procedural success rates were not different between the two groups (BIV vs HEP: OR 0.90 with 95% CI 0.49 to 1.64, p = 0.72) Conclusion: Compared with BIV, UFH was associated with more bleeding when used during PVI. There was no significant difference in procedural success between the two anticoagulation strategies.
KW - Bivalirudin
KW - Heparin
KW - Peripheral vascular interventions
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U2 - 10.1016/j.carrev.2018.01.010
DO - 10.1016/j.carrev.2018.01.010
M3 - Article
C2 - 29477790
AN - SCOPUS:85042175207
SN - 1553-8389
VL - 19
SP - 695
EP - 699
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 6
ER -