title: Bivalirudin versus unfractionated heparin for percutaneous coronary intervention with radial access: A meta-analysis of randomized trials.
abstract: BACKGROUND
  Radial access for percutaneous coronary intervention (PCI) has been shown to be associated with better outcomes compared with femoral access. However, it is unknown whether bivalirudin would offer any further benefit when compared with unfractionated heparin for PCI with radial access.
  
  
  METHODS
  A systematic search of electronic databases was conducted for randomized trials comparing bivalirudin with unfractionated heparin in patients undergoing PCI with a radial access. The primary safety outcome was major bleeding, while the primary efficacy outcome was major adverse cardiac events (MACE). Random effects overall risk ratios (RR) were calculated using DerSimonian and Laird model.
  
  
  RESULTS
  A total of 8044 patients from 5 trials were included in the final analysis. The incidence of major bleeding was 1.8% in the bivalirudin group versus 2.2% in the unfractionated heparin group (RR 0.72, 95% CI 0.44-1.17, p=0.18). Meta-regression analysis demonstrated that the risk of major bleeding was lower with bivalirudin when higher doses of unfractionated heparin were used in the control arm (p=0.02). The incidence of MACE was 8.5% in the bivalirudin group versus 7.5% in the unfractionated heparin group (RR 1.15, 95% CI 0.81-1.64, p=0.44). There were no significant differences in the incidence of all-cause mortality, and net adverse clinical events between both groups (RR 0.98, 95% CI 0.70-1.36, p=0.89; and RR 0.79, 95% C I0.60-1.03, p=0.08, respectively).
  
  
  CONCLUSIONS
  Bivalirudin might not be associated with better outcomes, when compared with unfractionated heparin in patients undergoing PCI with radial access.
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: ahmed.mahmoud@medicine.ufl.edu.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
authors.affiliation: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: islam.elgendy@medicine.ufl.edu.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000601:surgery*; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011884:Radius / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Anticoagulants; Bleeding; Coronary artery disease; Meta-analysis; Outcomes; Percutaneous coronary intervention