Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention

Rahman Shah, Ion S. Jovin, Amina Chaudhry, Showkat Haji, Raza Askari, Mallie M. Dennis, Chalak Berzingi, Sunil V. Rao

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: To evaluate the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). Background: Current guidelines favor bivalirudin for primary PCI in patients at high risk of bleeding, particularly when femoral access is used. However, patients with ST-segment elevation myocardial infarction frequently receive UFH before arrival in the catheterization laboratory. Methods: Scientific databases and websites were searched for randomized controlled trials. Patients were divided into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). Both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models were performed. Results: Data from five trials including13,547 patients were analyzed. In mixed-comparison models, switching to bivalirudin during primary PCI was associated with lower rates for all-cause mortality and major adverse cardiovascular events (MACEs) compared to the other strategies. Rates for all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar for the heparin and Biv-alone groups. Switching strategies was also associated with lower major bleeding rates compared to heparin alone. Similarly, in a standard pairwise model, both the switch and Biv-alone groups were associated with decreased bleeding risk compared to the heparin group. However, only the switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95% CI, 0.30–0.75; P = 0.001), MACE (RR, 0.67; 95% CI, 0.49–0.91; P = 0.012), and NACE (RR, 0.61; 95% CI, 0.41–0.92; P = 0.019) compared with heparin alone. Conclusions: During primary PCI, use of bivalirudin for those receiving preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, and all-cause mortality compared to heparin +/− GPI. This strategy was also associated with decreased rates for MACEs and all-cause mortality compared to bivalirudin alone without preprocedure UFH.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number2
DOIs
StatePublished - Feb 1 2019

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Percutaneous Coronary Intervention
Heparin
Safety
Mortality
Hemorrhage
bivalirudin
Platelet Glycoprotein GPIIb-IIIa Complex
Thigh
Catheterization
Meta-Analysis
Randomized Controlled Trials
Databases
Guidelines

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention. / Shah, Rahman; Jovin, Ion S.; Chaudhry, Amina; Haji, Showkat; Askari, Raza; Dennis, Mallie M.; Berzingi, Chalak; Rao, Sunil V.

In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 2, 01.02.2019, p. 241-247.

Research output: Contribution to journalArticle

Shah, Rahman ; Jovin, Ion S. ; Chaudhry, Amina ; Haji, Showkat ; Askari, Raza ; Dennis, Mallie M. ; Berzingi, Chalak ; Rao, Sunil V. / Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 2. pp. 241-247.
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abstract = "Objectives: To evaluate the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). Background: Current guidelines favor bivalirudin for primary PCI in patients at high risk of bleeding, particularly when femoral access is used. However, patients with ST-segment elevation myocardial infarction frequently receive UFH before arrival in the catheterization laboratory. Methods: Scientific databases and websites were searched for randomized controlled trials. Patients were divided into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). Both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models were performed. Results: Data from five trials including13,547 patients were analyzed. In mixed-comparison models, switching to bivalirudin during primary PCI was associated with lower rates for all-cause mortality and major adverse cardiovascular events (MACEs) compared to the other strategies. Rates for all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar for the heparin and Biv-alone groups. Switching strategies was also associated with lower major bleeding rates compared to heparin alone. Similarly, in a standard pairwise model, both the switch and Biv-alone groups were associated with decreased bleeding risk compared to the heparin group. However, only the switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95{\%} CI, 0.30–0.75; P = 0.001), MACE (RR, 0.67; 95{\%} CI, 0.49–0.91; P = 0.012), and NACE (RR, 0.61; 95{\%} CI, 0.41–0.92; P = 0.019) compared with heparin alone. Conclusions: During primary PCI, use of bivalirudin for those receiving preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, and all-cause mortality compared to heparin +/− GPI. This strategy was also associated with decreased rates for MACEs and all-cause mortality compared to bivalirudin alone without preprocedure UFH.",
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T1 - Safety and efficacy of switching from unfractionated heparin to bivalirudin during primary percutaneous coronary intervention

AU - Shah, Rahman

AU - Jovin, Ion S.

AU - Chaudhry, Amina

AU - Haji, Showkat

AU - Askari, Raza

AU - Dennis, Mallie M.

AU - Berzingi, Chalak

AU - Rao, Sunil V.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objectives: To evaluate the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). Background: Current guidelines favor bivalirudin for primary PCI in patients at high risk of bleeding, particularly when femoral access is used. However, patients with ST-segment elevation myocardial infarction frequently receive UFH before arrival in the catheterization laboratory. Methods: Scientific databases and websites were searched for randomized controlled trials. Patients were divided into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). Both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models were performed. Results: Data from five trials including13,547 patients were analyzed. In mixed-comparison models, switching to bivalirudin during primary PCI was associated with lower rates for all-cause mortality and major adverse cardiovascular events (MACEs) compared to the other strategies. Rates for all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar for the heparin and Biv-alone groups. Switching strategies was also associated with lower major bleeding rates compared to heparin alone. Similarly, in a standard pairwise model, both the switch and Biv-alone groups were associated with decreased bleeding risk compared to the heparin group. However, only the switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95% CI, 0.30–0.75; P = 0.001), MACE (RR, 0.67; 95% CI, 0.49–0.91; P = 0.012), and NACE (RR, 0.61; 95% CI, 0.41–0.92; P = 0.019) compared with heparin alone. Conclusions: During primary PCI, use of bivalirudin for those receiving preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, and all-cause mortality compared to heparin +/− GPI. This strategy was also associated with decreased rates for MACEs and all-cause mortality compared to bivalirudin alone without preprocedure UFH.

AB - Objectives: To evaluate the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). Background: Current guidelines favor bivalirudin for primary PCI in patients at high risk of bleeding, particularly when femoral access is used. However, patients with ST-segment elevation myocardial infarction frequently receive UFH before arrival in the catheterization laboratory. Methods: Scientific databases and websites were searched for randomized controlled trials. Patients were divided into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). Both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models were performed. Results: Data from five trials including13,547 patients were analyzed. In mixed-comparison models, switching to bivalirudin during primary PCI was associated with lower rates for all-cause mortality and major adverse cardiovascular events (MACEs) compared to the other strategies. Rates for all-cause mortality, MACEs, and net adverse clinical events (NACEs) were similar for the heparin and Biv-alone groups. Switching strategies was also associated with lower major bleeding rates compared to heparin alone. Similarly, in a standard pairwise model, both the switch and Biv-alone groups were associated with decreased bleeding risk compared to the heparin group. However, only the switch strategy was associated with decreased all-cause mortality (RR, 0.47; 95% CI, 0.30–0.75; P = 0.001), MACE (RR, 0.67; 95% CI, 0.49–0.91; P = 0.012), and NACE (RR, 0.61; 95% CI, 0.41–0.92; P = 0.019) compared with heparin alone. Conclusions: During primary PCI, use of bivalirudin for those receiving preprocedure UFH was associated decreased rates for major bleeding, NACEs, MACEs, and all-cause mortality compared to heparin +/− GPI. This strategy was also associated with decreased rates for MACEs and all-cause mortality compared to bivalirudin alone without preprocedure UFH.

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