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The anticoagulant of choice during percutaneous coronary intervention (PCI) in females remains debatable. We aim to evaluate outcomes of bivalirudin versus heparin in females undergoing PCI.
Electronic search of MEDLINE and Cochrane Library databases was conducted for trials that randomized PCI patients to bivalirudin versus heparin and reported subgroup analysis of outcomes in females. Random effects DerSimonian-Laird risk ratios (RR) were calculated. Outcomes included major adverse cardiac events (MACE; defined in most trials as composite of death, MI, or target vessel revascularization), net adverse cardiac events (NACE; defined in most trials as composite of MACE and major bleeding), and major bleeding.
Eight trials with total of 8,532 females (4,261 in bivalirudin arm and 4,271 in heparin arm) were included. 4 trials reported MACE at 1-year. MACE were similar in females who received bivalirudin compared with heparin at 30 days (RR=0.96; 95%CI 0.77-1.21; p=0.74) (Figure 1), and 1 year (RR=0.95; 95%CI 0.84-1.08; p=0.42). All-cause mortality was also similar at 30 days and 1 year ((RR=0.84; 95%CI 0.40-1.76; p=0.65; and RR=0.94; 95% CI 0.53-1.67; p=0.83, respectively). However; females randomized to bivalirudin had less NACE compared with heparin at 30 days (RR=0.84; 95%CI 0.72-0.99; p=0.04) (Figure 2). Major bleeding was similar in females randomized to either groups (RR=0.93; 95%CI 0.73-1.19; p=0.59) (Figure 3).
Bivalirudin might be associated with better outcomes in females undergoing PCI compared with heparin.
CORONARY: PCI Outcomes