title: Heparin is Not Inferior to Bivalirudin in Percutaneous Coronary Intervention-Focusing on the Effect of Glycoprotein IIb/IIIa Inhibitor Use: A Meta-Analysis.
abstract: Our aim was to compare the efficacy and safety of bivalirudin (Biv) versus heparin (Hep) with or without similar usage rate of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI). The PubMed and EMbase were searched. Randomized trials comparing Biv versus Hep were eligible for inclusion. With imbalanced GPI use, Biv had significantly lower major bleeding (pooled risk ratio [RR], 0.67; 95% confidence interval [CI], 0.54-0.83) without difference in mortality (pooled RR, 0.95; 95% CI, 0.80-1.14). With comparable GPI use, no significant difference was observed in major bleeding (pooled RR, 0.95; 95% CI, 0.82-1.10) and mortality (pooled RR, 1.13; 95% CI, 0.85-1.50). With no GPI use, Biv was associated with numerically higher mortality (pooled RR, 1.17; 95% CI, 0.83-1.65) without significant difference in major bleeding (pooled RR, 0.81; 95% CI, 0.64-1.02). In conclusion, when comparing different anticoagulants during PCI, the effect of GPIs should not be underestimated. Heparin as such was found noninferior to Biv.
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Fang-Yang
authors: FY
authors: Huang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Bao-Tao
authors: BT
authors: Huang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Yong
authors: Y
authors: Peng
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Wei
authors: W
authors: Liu
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Zhen-Gang
authors: ZG
authors: Zhao
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Peng-Ju
authors: PJ
authors: Wang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Zhi-Liang
authors: ZL
authors: Zuo
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Chen
authors: C
authors: Zhang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Yan-Biao
authors: YB
authors: Liao
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Xiao-Lin
authors: XL
authors: Luo
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Qing-Tao
authors: QT
authors: Meng
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Chi
authors: C
authors: Chen
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Kai-Sen
authors: KS
authors: Huang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Hua
authors: H
authors: Chai
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Qiao
authors: Q
authors: Li
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China hmaochen@vip.sina.com.
authors: Mao
authors: M
authors: Chen
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Ye
authors: Y
authors: Zhu
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D016017:Odds Ratio; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: bivalirudin; glycoprotein IIb/IIIa inhibitor; heparin; percutaneous coronary intervention