title: Hemorrhagic and ischemic outcomes of Heparin vs. Bivalirudin in carotid artery stenting: A meta-analysis of studies.
abstract: BACKGROUND
  Bivalirudin, has been shown to have comparable efficacy and better safety profile when compared to unfractionated heparin (UFH) in percutaneous coronary interventions. Bivalirudin's safety in carotid artery stenting (CAS) was associated with better outcomes than heparin in some studies. In this Meta analysis we examine the hemorrhagic and ischemic outcomes associated with Bivalirudin compared to UFH during CAS.
  
  
  METHODS
  A comprehensive literature search was conducted with the electronic databases MEDLINE, EMBASE, and CENTRAL. Random-effects meta-analysis method was used to pool risk ratio (RR) for both Heparin and Bivalirudin with 95% confidence interval (CI). Study outcomes included hemorrhagic complications; major/minor bleeding and intracranial hemorrhage (ICH) as well as ischemic complications including ischemic stroke, myocardial infarction, and 30 day mortality.
  
  
  RESULTS
  A total of four studies were included enrolling 7,784 patients. Compared to UFH, Bivalirudin was associated with significantly lower major bleeding events with a relative risk (RR) of 0.53 (95% CI: 0.35-0.80; I2= 0%). Minor bleeding events were significantly lower in the Bivalirudin group with a RR of 0.41 (95% CI: 0.2-0.82; I2= 0%). Looking into other outcomes, there were no significant differences between anticoagulation strategies in terms of ischemic stroke (RR 0.8, with 95% CI: 0.60-1.06), intracranial hemorrhage (RR 0.73 with 95% CI: 0.27-1.98), myocardial infarction (RR 1.01 with 95% CI: 0.59-1.73) or 30 day mortality (RR 0.83 with 95% CI: 0.47-1.47).
  
  
  CONCLUSIONS
  Compared to UFH, Bivalirudin is associated with lower bleeding risk when used during CAS. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Cardiovascular Medicine Department at the University of Missouri-Columbia School of Medicine, Columbia, Missouri.
authors.forename: Jad
authors.initials: J
authors.lastname: Omran
authors.affiliation: Internal Medicine Department, University of Florida Collage of Medicine, Gainesville, Florida.
authors.forename: Obai
authors.initials: O
authors.lastname: Abdullah
authors.affiliation: Internal Medicine Department, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Mazen
authors.initials: M
authors.lastname: Abu-Fadel
authors.affiliation: Department of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
authors.affiliation: Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.affiliation: Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Drachman
authors.affiliation: Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California-San Diego, La Jolla, California.
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.affiliation: Department of Cardiology, Lifespan Cardiovascular Institue, Providence, Rhode Island.
authors.forename: Herebert D
authors.initials: HD
authors.lastname: Aronow
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: White
authors.affiliation: Prairie Heart Institute, Springfield, IL.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Al-Dadah
mesh_terms: D000991:Antithrombins / Q000494:pharmacology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000494:pharmacology; D014943:Global Health; D006493:Heparin / Q000494:pharmacology*; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D015994:Incidence; D010446:Peptide Fragments / Q000494:pharmacology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011994:Recombinant Proteins / Q000494:pharmacology; D015607:Stents
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: bivalirudin; carotid artery stenting; heparin; major bleeding; minor bleeding