Department of Medicine, University of Kentucky, KY, USA.
Department of Cardiovascular Medicine, University of Iowa, IA, USA.
Cardiovasc Revasc Med. 2024 Apr;61:52-61. doi: 10.1016/j.carrev.2023.10.014. Epub 2023 Oct 19.
Bivalirudin is an alternative accepted therapy to unfractionated heparin for patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). We aimed in this meta-analysis to compare bivalirudin versus unfractionated heparin in patients with MI undergoing PCI.
We have screened PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov (inception through January 8th, 2023) for randomized controlled trials (RCTs) evaluating bivalirudin versus unfractionated heparin in patients with MI undergoing PCI. The DerSimonian and Laird method was used for estimation of tau2 to calculate the risk ratio (RR) and 95 % confidence interval (CI).
Ten RCTs with a total of 40,069 participants were included in our analysis. Bivalirudin as compared with unfractionated heparin was associated with significant decrease in major bleeding (RR 0.64 [0.52 to 0.79]; p < 0.01; I2 = 69 %) and cardiovascular mortality (RR 0.79 [0.67 to 0.92]; p < 0.01; I2 = 0 %). There was no significant difference between bivalirudin and unfractionated heparin groups in terms of major adverse cardiovascular events (RR 1.02 [0.91 to 1.14]; p = 0.73; I2 = 52 %), all-cause mortality (RR 0.89 [0.77 to 1.04]; p = 0.15; I2 = 23 %), MI (RR 1.02 [0.87 to 1.19]; p = 0.80; I2 = 36 %), stent thrombosis (RR 1.12 [0.52 to 2.40]; p = 0.77; I2 = 82 %), or stroke (RR 0.97 [0.73 to 1.29]; p = 0.85; I2 = 0 %).
Our meta-analysis suggests that bivalirudin compared with unfractionated heparin in patients with MI undergoing PCI was associated with lower rates of major bleeding and cardiovascular mortality without a significant difference in major adverse cardiovascular events, all-cause mortality, MI, stroke, or stent thrombosis.
比伐卢定是一种替代普通肝素的疗法，适用于接受经皮冠状动脉介入治疗（PCI）的心肌梗死（MI）患者。我们旨在这项荟萃分析中比较比伐卢定与普通肝素在接受 PCI 的 MI 患者中的疗效。
我们在 PubMed/MEDLINE、Cochrane 图书馆和 ClinicalTrials.gov（从创建至 2023 年 1 月 8 日）中筛选了评价 MI 患者接受 PCI 时比伐卢定与普通肝素的随机对照试验（RCT）。采用 DerSimonian 和 Laird 方法估计 tau2 以计算风险比（RR）和 95%置信区间（CI）。
纳入了 10 项 RCT，共有 40069 名参与者。与普通肝素相比，比伐卢定与显著降低大出血（RR 0.64 [0.52 至 0.79]；p<0.01；I2=69%）和心血管死亡率（RR 0.79 [0.67 至 0.92]；p<0.01；I2=0）相关。在主要不良心血管事件（RR 1.02 [0.91 至 1.14]；p=0.73；I2=52%）、全因死亡率（RR 0.89 [0.77 至 1.04]；p=0.15；I2=23%）、心肌梗死（RR 1.02 [0.87 至 1.19]；p=0.80；I2=36%）、支架血栓形成（RR 1.12 [0.52 至 2.40]；p=0.77；I2=82%）或卒中（RR 0.97 [0.73 至 1.29]；p=0.85；I2=0）方面，比伐卢定与普通肝素组之间无显著差异。
我们的荟萃分析表明，与普通肝素相比，MI 患者接受 PCI 时使用比伐卢定与较低的大出血发生率和心血管死亡率相关，而主要不良心血管事件、全因死亡率、心肌梗死、卒中和支架血栓形成的发生率无显著差异。
