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Background: Randomized clinical trials (RCTs) comparing heparin with bivalirudin during percutaneous coronary intervention (PCI) for myocardial infarction (MI) have produced mixed results: heparin may be associated with a lower risk of acute stent thrombosis (ST) but more bleeding. We tested the hypothesis that use of radial access has eliminated the observed bleeding advantage of bivalirudin.
Methods: Aggregate data from the radial subgroups from RCTs were analyzed using traditional and Bayesian hierarchical meta-analysis.
Results: A total of 8018 patients in 5 RCTs had transradial PCI and were randomized to heparin or bivalirudin (Figure). Although pooled results suggested marginally more bleeding with heparin than with bivalirudin (posterior median odds ratio [OR]: 1.58; 95% Bayesian confidence interval [BCI]: 1.04 to 2.69), this was partly offset by nominally lower rates of acute ST (OR: 0.48; 95% BCI: 0.23 to 1.02) and no difference in mortality (OR: 1.16; 95% BCI: 0.74 to 2.02). For every 1000 patients with radial access who were randomized to heparin, there were 13 (95% BCI: 1 to 37) more bleeds and 6 (95% BCI: -1 to 8) fewer episodes of acute ST.
Conclusions: Use of heparin in place of bivalirudin during transradial PCI is associated with marginally increased bleeding and a nominally lower risk of acute ST. Future studies should investigate the optimal dosing of heparin and the safety of high-dose bivalirudin infusions post PCI to improve the outcomes of patients undergoing transradial PCI.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Optimizing the Care of ACS Patients
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1284-150
- 2017 American College of Cardiology Foundation