Bivalirudin versus unfractionated heparin in peripheral vascular interventions

Jad Omran, Tariq Enezate, Obai Abdullah, Ashraf S. Al-Dadah, Herbert D. Aronow, Jihad Mustapha, Fadi Saab, Emmanouil S. Brilakis, Ryan R. Reeves, Deepak L. Bhatt, Ehtisham Mahmud

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - Jan 1 2018

    Fingerprint

Keywords

  • Bivalirudin
  • Heparin
  • Peripheral vascular interventions

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Omran, J., Enezate, T., Abdullah, O., Al-Dadah, A. S., Aronow, H. D., Mustapha, J., Saab, F., Brilakis, E. S., Reeves, R. R., Bhatt, D. L., & Mahmud, E. (Accepted/In press). Bivalirudin versus unfractionated heparin in peripheral vascular interventions. Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2018.01.010