Author + information
- Harold Rivner,
- Rajiv Parmar and
- Rhanderson Cardoso
Introduction: Heparin-induced thrombocytopenia (HIT) is associated with significant thromboembolic risk and reported mortality of 20%. Currently, the only FDA approved therapy for HIT is argatroban. Bivalirudin has been suggested as an alternative anticoagulant for HIT. However, studies comparing bivalirudin to argatroban have shown conflicting results.
Methods: We aimed to perform a meta-analysis comparing the rate of thromboembolic events, bleeding risk, and all-cause mortality between patients with HIT treated with either argatroban or bivalirudin. PubMed, Cochrane, and manuscript references were searched. Odds-ratios were computed in fixed and random-effects model as appropriate, and heterogeneity was assessed with I2 statistics.
Results: 5 retrospective studies that directly compared bivalirudin with argatroban in the treatment of HIT were included with a total of 386 patients. Of these, 168 (43.5%) received bivalirudin therapy. No significant difference was observed in thromboembolic events (OR 1.33; 95% CI 0.62-2.88; p=0.47), bleeding (OR 0.90; 95% CI 0.50-1.61; p=0.71), or all-cause mortality (OR 0.62; 95% CI 0.30-1.27; p=0.19).
Conclusions: The results indicate no difference between bivalirudin and argatroban in the rates of thromboembolic events, bleeding, or all-cause mortality in HIT. Bivalirudin may serve as a therapeutic alternative in HIT, given its shorter half-life, faster titration, better safety profile, and potentially lower cost as compared to argatroban.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cutting Edge Vascular Medicine
Abstract Category: 38. Vascular Medicine: Basic
Presentation Number: 1205-359
- 2017 American College of Cardiology Foundation