Author + information
- Wilman Olmedo1,
- Pedro Villablanca2,
- Michael Weinreich3,
- Tanush Gupta4,
- Divyanshu Mohananey5,
- Thomas Brevik6,
- Cristina Sanina1,
- Jeannine Brevik7,
- Muhammad Farooq8,
- Harish Ramakrishna9,
- Robert Pyo8,
- Mario Garcia1 and
- Jose Wiley1
- 1Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
- 2New York University, New York, New York, United States
- 3Montefiore Medical Center, Bronx, New York, United States
- 4Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
- 5Cleveland Clinic, Cleveland, Ohio, United States
- 6Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
- 7Allegheny General Hospital, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
- 8Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
- 9Mayo Clinic, Phoenix, Arizona, United States
Bivalirudin may be an effective anticoagulation alternative to heparin as anticoagulant agent in percutaneous peripheral interventions (PPI). We aimed to compare safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing PPI.
We conducted an electronic database search of all published data. The primary endpoint was all-cause mortality. Secondary outcomes were stroke, myocardial infarction, all-bleeding, major bleeding, minor bleeding, intracranial bleeding, blood transfusion, amputations, access site complications, and length of stay. Odds ratios (OR), difference in means (DM), and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Fixed-effect model was used; if heterogeneity (I2)>25 effects were obtained using a random model.
Eleven studies (n=36,773 patients) were included in the analysis. There was a significant difference favoring bivalirudin over haparin for all-cause mortality (OR 0.47, 95% CI 0.24-0.93), stroke (OR 0.73, 95% CI 0.56-0.96), all-bleeding (OR 0.59 95% CI 0.46-0.76), major bleeding (OR 0.58, 95% CI 0.41-0.80), minor bleeding (OR 0.63 95% CI 0.43-0.92), and amputations (OR 0.29, 95% CI 0.22-0.38). There was no significant difference in myocardial infarction (OR 0.72, 95% CI 0.38-1.36), intracranial bleeding (OR 0.76, 95% CI 0.20-2.03), blood transfusion (OR 0.72 95% CI 0.34-1.52), access site complication (OR 0.75, 95% CI 0.54-1.05), and length of stay (DM -0.15, 95% CI -0.86-0.56).
Our meta-analysis suggests that use of bivalirudin compared to heparin for PPI is associated with lower all-cause mortality, bleeding, stroke and amputations. Further large randomized trials are needed to confirm current results.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention