Bivalirudin Versus Heparin Plus Glycoprotein IIb/IIIa Inhibitors in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

A Meta-Analysis of Randomized Controlled Trials

Uzoma Ibebuogu, Oluwaseyi Bolorunduro, Smith Giri, Samuel Dagogo-Jack, Blake G. Smith, Saibal Kar, Guy Reed

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6 Citations (Scopus)

Abstract

Diabetes mellitus (DM) is a pro-thrombotic state with enhanced thrombin generation and platelet reactivity. For most patients undergoing percutaneous coronary intervention (PCI), bivalirudin demonstrates efficacy comparable with that of heparin and glycoprotein IIb/IIIa inhibitors (GPIs). Yet, because of their pro-thrombotic condition, we hypothesized that patients with DM may benefit from more aggressive dual antithrombin and antiplatelet therapy. The aim of this paper was to provide a systematic review comparing outcomes of PCI with bivalirudin versus heparin plus GPI in patients with DM using meta-analytical techniques. Eligible studies needed to have reported a subgroup analysis of outcomes among diabetic patients. Six trials comprising 5924 diabetic patients were eligible. At 30 days, bivalirudin was associated with a reduction in net adverse cardiac events [relative risk (RR) 0.81, 95 % confidence interval (CI) 0.70–0.93, p = 0.002] and major bleeds (RR 0.68, 95 % CI 0.49–0.95; p = 0.02), with no difference in composite ischemia (RR 0.92, 95 % CI 0.74–1.14; p = 0.43) or mortality (RR 0.71, 95 % CI 0.45–1.13; p = 0.15). At 1 year, bivalirudin was associated with a significant reduction in all-cause mortality (RR 0.73, 95 % CI 0.54–1.00, p = 0.05) despite similar composite ischemia (RR 1.02, 95 % CI 0.56–1.21, p = 0.811). In conclusion, thrombin inhibition with bivalirudin alone was associated with reduced 30-day major bleeding and 1-year all-cause mortality compared with heparin plus GPI in diabetic patients undergoing PCI.

Original languageEnglish (US)
Pages (from-to)275-285
Number of pages11
JournalAmerican Journal of Cardiovascular Drugs
Volume15
Issue number4
DOIs
StatePublished - Aug 25 2015

Fingerprint

Platelet Glycoprotein GPIIb-IIIa Complex
Percutaneous Coronary Intervention
Heparin
Meta-Analysis
Diabetes Mellitus
Randomized Controlled Trials
Confidence Intervals
Thrombin
Mortality
Ischemia
Antithrombins
bivalirudin
Blood Platelets
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

@article{677cf05380e046e5a759636f95df4155,
title = "Bivalirudin Versus Heparin Plus Glycoprotein IIb/IIIa Inhibitors in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials",
abstract = "Diabetes mellitus (DM) is a pro-thrombotic state with enhanced thrombin generation and platelet reactivity. For most patients undergoing percutaneous coronary intervention (PCI), bivalirudin demonstrates efficacy comparable with that of heparin and glycoprotein IIb/IIIa inhibitors (GPIs). Yet, because of their pro-thrombotic condition, we hypothesized that patients with DM may benefit from more aggressive dual antithrombin and antiplatelet therapy. The aim of this paper was to provide a systematic review comparing outcomes of PCI with bivalirudin versus heparin plus GPI in patients with DM using meta-analytical techniques. Eligible studies needed to have reported a subgroup analysis of outcomes among diabetic patients. Six trials comprising 5924 diabetic patients were eligible. At 30 days, bivalirudin was associated with a reduction in net adverse cardiac events [relative risk (RR) 0.81, 95 {\%} confidence interval (CI) 0.70–0.93, p = 0.002] and major bleeds (RR 0.68, 95 {\%} CI 0.49–0.95; p = 0.02), with no difference in composite ischemia (RR 0.92, 95 {\%} CI 0.74–1.14; p = 0.43) or mortality (RR 0.71, 95 {\%} CI 0.45–1.13; p = 0.15). At 1 year, bivalirudin was associated with a significant reduction in all-cause mortality (RR 0.73, 95 {\%} CI 0.54–1.00, p = 0.05) despite similar composite ischemia (RR 1.02, 95 {\%} CI 0.56–1.21, p = 0.811). In conclusion, thrombin inhibition with bivalirudin alone was associated with reduced 30-day major bleeding and 1-year all-cause mortality compared with heparin plus GPI in diabetic patients undergoing PCI.",
author = "Uzoma Ibebuogu and Oluwaseyi Bolorunduro and Smith Giri and Samuel Dagogo-Jack and Smith, {Blake G.} and Saibal Kar and Guy Reed",
year = "2015",
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T1 - Bivalirudin Versus Heparin Plus Glycoprotein IIb/IIIa Inhibitors in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

T2 - A Meta-Analysis of Randomized Controlled Trials

AU - Ibebuogu, Uzoma

AU - Bolorunduro, Oluwaseyi

AU - Giri, Smith

AU - Dagogo-Jack, Samuel

AU - Smith, Blake G.

AU - Kar, Saibal

AU - Reed, Guy

PY - 2015/8/25

Y1 - 2015/8/25

N2 - Diabetes mellitus (DM) is a pro-thrombotic state with enhanced thrombin generation and platelet reactivity. For most patients undergoing percutaneous coronary intervention (PCI), bivalirudin demonstrates efficacy comparable with that of heparin and glycoprotein IIb/IIIa inhibitors (GPIs). Yet, because of their pro-thrombotic condition, we hypothesized that patients with DM may benefit from more aggressive dual antithrombin and antiplatelet therapy. The aim of this paper was to provide a systematic review comparing outcomes of PCI with bivalirudin versus heparin plus GPI in patients with DM using meta-analytical techniques. Eligible studies needed to have reported a subgroup analysis of outcomes among diabetic patients. Six trials comprising 5924 diabetic patients were eligible. At 30 days, bivalirudin was associated with a reduction in net adverse cardiac events [relative risk (RR) 0.81, 95 % confidence interval (CI) 0.70–0.93, p = 0.002] and major bleeds (RR 0.68, 95 % CI 0.49–0.95; p = 0.02), with no difference in composite ischemia (RR 0.92, 95 % CI 0.74–1.14; p = 0.43) or mortality (RR 0.71, 95 % CI 0.45–1.13; p = 0.15). At 1 year, bivalirudin was associated with a significant reduction in all-cause mortality (RR 0.73, 95 % CI 0.54–1.00, p = 0.05) despite similar composite ischemia (RR 1.02, 95 % CI 0.56–1.21, p = 0.811). In conclusion, thrombin inhibition with bivalirudin alone was associated with reduced 30-day major bleeding and 1-year all-cause mortality compared with heparin plus GPI in diabetic patients undergoing PCI.

AB - Diabetes mellitus (DM) is a pro-thrombotic state with enhanced thrombin generation and platelet reactivity. For most patients undergoing percutaneous coronary intervention (PCI), bivalirudin demonstrates efficacy comparable with that of heparin and glycoprotein IIb/IIIa inhibitors (GPIs). Yet, because of their pro-thrombotic condition, we hypothesized that patients with DM may benefit from more aggressive dual antithrombin and antiplatelet therapy. The aim of this paper was to provide a systematic review comparing outcomes of PCI with bivalirudin versus heparin plus GPI in patients with DM using meta-analytical techniques. Eligible studies needed to have reported a subgroup analysis of outcomes among diabetic patients. Six trials comprising 5924 diabetic patients were eligible. At 30 days, bivalirudin was associated with a reduction in net adverse cardiac events [relative risk (RR) 0.81, 95 % confidence interval (CI) 0.70–0.93, p = 0.002] and major bleeds (RR 0.68, 95 % CI 0.49–0.95; p = 0.02), with no difference in composite ischemia (RR 0.92, 95 % CI 0.74–1.14; p = 0.43) or mortality (RR 0.71, 95 % CI 0.45–1.13; p = 0.15). At 1 year, bivalirudin was associated with a significant reduction in all-cause mortality (RR 0.73, 95 % CI 0.54–1.00, p = 0.05) despite similar composite ischemia (RR 1.02, 95 % CI 0.56–1.21, p = 0.811). In conclusion, thrombin inhibition with bivalirudin alone was associated with reduced 30-day major bleeding and 1-year all-cause mortality compared with heparin plus GPI in diabetic patients undergoing PCI.

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