Comparison of heparin, bivalirudin, and different glycoprotein IIb/IIIa inhibitor regimens for anticoagulation during percutaneous coronary intervention: A network meta-analysis

Autor: Michael J. Lipinski, Michael A. Gaglia, Lowell F. Satler, Ron Waksman, Rebecca Torguson, Regina C. Lee, Augusto D. Pichard, Hector M. Garcia-Garcia
Rok vydání: 2016
Předmět:
Male
Acute coronary syndrome
medicine.medical_specialty
Time Factors
Myocardial Infarction
Hemorrhage
Platelet Glycoprotein GPIIb-IIIa Complex
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Abciximab
Humans
Bivalirudin
Blood Transfusion
030212 general & internal medicine
Aged
Heparin
business.industry
Coronary Thrombosis
Anticoagulants
Bayes Theorem
General Medicine
Tirofiban
Hirudins
Middle Aged
medicine.disease
Clopidogrel
Thrombocytopenia
Peptide Fragments
Recombinant Proteins
Treatment Outcome
Glycoprotein IIb/IIIa inhibitors
Eptifibatide
Cardiology
Drug Therapy
Combination
Female
Cardiology and Cardiovascular Medicine
business
Glycoprotein IIb/IIIa
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: Cardiovascular Revascularization Medicine. 17:535-545
ISSN: 1553-8389
DOI: 10.1016/j.carrev.2016.09.011
Popis: Background/purpose Numerous GPIs are available for PCI. Although they were tested in randomized controlled trials, a comparison between the different GPI strategies is lacking. Thus, we performed a Bayesian network meta-analysis to compare different glycoprotein IIb/IIIa inhibitor (GPI) strategies with heparin and bivalirudin for percutaneous coronary intervention (PCI). Methods MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov were searched by two independent reviewers for randomized controlled trials comparing high-dose bolus tirofiban, abciximab, eptifibatide, heparin with provisional glycoprotein IIb/IIIa inhibitors, and bivalirudin with provisional GPI that reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare between different anticoagulation strategies for all-cause mortality, myocardial infarction, major adverse cardiovascular events, major bleeding, minor bleeding, need for transfusion, and thrombocytopenia. Results A total of 41 randomized controlled trials with 38,645 patients were included in the analysis, among which 2654 were randomized to high-dose bolus tirofiban, 6752 to abciximab, 1669 to eptifibatide, 16,500 to heparin, and 11,070 to bivalirudin. Mean age was 64±11years, 75% were male, 91% were treated with stenting, 71% with clopidogrel, and 74% for acute coronary syndrome. High-dose bolus tirofiban was associated with a significant reduction in all-cause mortality compared with heparin (OR 0.57 [credible intervals 0.37, 0.9]) and eptifibatide (OR 0.44 [credible intervals 0.19, 1.0]). GPI regimens had less myocardial infarction and major adverse cardiovascular events but greater bleeding compared with heparin and bivalirudin. There was no difference among the GPI therapies for other outcomes, including myocardial infarction, major adverse cardiovascular events, and major bleeding. Conclusions Our network meta-analysis of 38,645 patients demonstrated that GPI regimens were associated with a reduction in recurrent myocardial infarction or major adverse cardiovascular events for PCI, while bivalirudin was associated with the lowest risk of bleeding.
Databáze: OpenAIRE
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