Department of Medicine, University of Tennessee, Memphis TN.
Department of Cardiology, Gulf Coast Medical Center, Panama City, FL.
J Cardiovasc Pharmacol. 2021 Jul 1;78(1):e40-e44. doi: 10.1097/FJC.0000000000001029.
Bivalirudin and heparin are the principal anticoagulants used during primary percutaneous coronary intervention (PCI) for patients experiencing ST-elevation myocardial infarctions. Based on previous meta-analyses, bivalirudin improves 30-day mortality rates compared with heparin, especially when vascular access is predominantly femoral. However, no meta-analysis has yet reported whether this mortality benefit with bivalirudin persists beyond 30 days. Scientific databases and websites were searched to find randomized controlled trials, and risk ratios (RRs) were calculated using random effect models. Data from 4 trials were analyzed. Compared with heparin ± glycoprotein IIb/IIIa inhibitors, bivalirudin decreased all-cause mortality [RR, 0.81; 95% confidence interval (CI), 0.69-0.94; P = 0.008], cardiac mortality (RR, 0.72; 95% CI, 0.60-0.88; P = 0.001), and net adverse clinical events (RR, 0.83; 95% CI, 0.72-0.97; P = 0.016) at 1 year. In conclusion, a bivalirudin-based anticoagulation strategy during primary percutaneous coronary intervention significantly decreases the 1-year risks for all-cause mortality, cardiac mortality, and net adverse clinical events compared with heparin ± glycoprotein IIb/IIIa inhibitor.
比伐卢定和肝素是用于 ST 段抬高型心肌梗死患者的经皮冠状动脉介入治疗（PCI）的主要抗凝剂。基于之前的荟萃分析，与肝素相比，比伐卢定可降低 30 天死亡率，尤其是当血管入路主要是股动脉时。然而，目前尚无荟萃分析报告比伐卢定的这种死亡率获益是否会持续超过 30 天。检索科学数据库和网站以寻找随机对照试验，并使用随机效应模型计算风险比（RR）。分析了 4 项试验的数据。与肝素+糖蛋白 IIb/IIIa 抑制剂相比，比伐卢定降低了全因死亡率[RR，0.81；95%置信区间（CI），0.69-0.94；P = 0.008]、心脏死亡率[RR，0.72；95%CI，0.60-0.88；P = 0.001]和净不良临床事件[RR，0.83；95%CI，0.72-0.97；P = 0.016]在 1 年内。总之，与肝素+糖蛋白 IIb/IIIa 抑制剂相比，在经皮冠状动脉介入治疗中采用比伐卢定抗凝策略可显著降低 1 年内全因死亡率、心脏死亡率和净不良临床事件的风险。
