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Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention.

Publication ,  Journal Article
Shah, R; Jovin, IS; Chaudhry, A; Haji, SA; Askari, R; Dennis, MM; Berzingi, C; Rao, SV
Published in: Catheter Cardiovasc Interv
February 1, 2019

OBJECTIVES: To evaluate the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). BACKGROUND: Current guidelines favor bivalirudin for primary PCI in patients at high risk of bleeding, particularly when femoral access is used. However, patients with ST-segment elevation myocardial infarction frequently receive UFH before arrival in the catheterization laboratory. METHODS: Scientific databases and websites were searched for randomized controlled trials. Patients were divided into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). Both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models were performed. RESULTS: Data from five trials including13,547 patients were analyzed. In mixed-comparison models, switching to bivalirudin during primary PCI was associated with lower rates for all-cause mortality and major adverse cardiovascular events (MACEs) compared to the other strategies. Rates for all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar for the heparin and Biv-alone groups. Switching strategies was also associated with lower major bleeding rates compared to heparin alone. Similarly, in a standard pairwise model, both the switch and Biv-alone groups were associated with decreased bleeding risk compared to the heparin group. However, only the switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95% CI, 0.30-0.75; P = 0.001), MACE (RR, 0.67; 95% CI, 0.49-0.91; P = 0.012), and NACE (RR, 0.61; 95% CI, 0.41-0.92; P = 0.019) compared with heparin alone. CONCLUSIONS: During primary PCI, use of bivalirudin for those receiving preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, and all-cause mortality compared to heparin +/- GPI. This strategy was also associated with decreased rates for MACEs and all-cause mortality compared to bivalirudin alone without preprocedure UFH.

Duke Scholars

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

February 1, 2019

Volume

93

Issue

2

Start / End Page

241 / 247

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Recombinant Proteins
  • Percutaneous Coronary Intervention
  • Peptide Fragments
  • Network Meta-Analysis
  • Humans
  • Hirudins
 

Citation

APA
Chicago
ICMJE
MLA
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Shah, R., Jovin, I. S., Chaudhry, A., Haji, S. A., Askari, R., Dennis, M. M., … Rao, S. V. (2019). Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention. Catheter Cardiovasc Interv, 93(2), 241–247. https://doi.org/10.1002/ccd.27828
Shah, Rahman, Ion S. Jovin, Amina Chaudhry, Showkat A. Haji, Raza Askari, Mallie M. Dennis, Chalak Berzingi, and Sunil V. Rao. “Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention.Catheter Cardiovasc Interv 93, no. 2 (February 1, 2019): 241–47. https://doi.org/10.1002/ccd.27828.
Shah R, Jovin IS, Chaudhry A, Haji SA, Askari R, Dennis MM, et al. Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention. Catheter Cardiovasc Interv. 2019 Feb 1;93(2):241–7.
Shah, Rahman, et al. “Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention.Catheter Cardiovasc Interv, vol. 93, no. 2, Feb. 2019, pp. 241–47. Pubmed, doi:10.1002/ccd.27828.
Shah R, Jovin IS, Chaudhry A, Haji SA, Askari R, Dennis MM, Berzingi C, Rao SV. Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention. Catheter Cardiovasc Interv. 2019 Feb 1;93(2):241–247.
Journal cover image

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

February 1, 2019

Volume

93

Issue

2

Start / End Page

241 / 247

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Recombinant Proteins
  • Percutaneous Coronary Intervention
  • Peptide Fragments
  • Network Meta-Analysis
  • Humans
  • Hirudins