Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis
Identifieur interne : 004510 ( Main/Exploration ); précédent : 004509; suivant : 004511Relative efficacy of bivalirudin versus heparin monotherapy in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a network meta-analysis
Auteurs : Tim Kinnaird [Royaume-Uni] ; Goran Medic [Pays-Bas] ; Gianni Casella [Italie] ; Francois Schiele [France] ; Upendra Kaul [Inde] ; Peter W. Radke [Allemagne] ; Indra Eijgelshoven [Pays-Bas] ; Gert Bergman [Pays-Bas] ; Derek P. Chew [Australie]Source :
- Journal of Blood Medicine [ 1179-2736 ] ; 2013.
Abstract
In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32–0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37–2.13), myocardial infarction (OR, 0.79; CrL, 0.40–1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45–0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.
Url:
DOI: 10.2147/JBM.S50595
PubMed: 24124401
PubMed Central: 3794970
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><p>In the absence of head-to-head clinical data, the objective of this study was to indirectly compare the efficacy and safety of a bivalirudin-based anticoagulation strategy with that of heparin monotherapy in patients with ST-elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention. A systematic literature review was performed to identify randomized controlled trials to build a network of bivalirudin and heparin monotherapy strategies in STEMI patients using heparin, with glycoprotein IIb/IIIa inhibitor as a common reference strategy. At 30 days, the bivalirudin-based strategy was expected to result in lower mortality rates than heparin monotherapy (odds ratio [OR], 0.55; credible limit [CrL], 0.32–0.95). This relationship was sustained at 1 year. At 30 days, the risk for stroke (OR, 0.88; CrL, 0.37–2.13), myocardial infarction (OR, 0.79; CrL, 0.40–1.55), and thrombolysis in myocardial infarction major and minor bleedings (OR, 0.66; CrL, 0.45–0.98) tended to be numerically reduced with bivalirudin in comparison with heparin monotherapy. For patients with STEMI intended for primary percutaneous coronary intervention, bivalirudin is associated with lower mortality rates in comparison with heparin monotherapy. This study suggests that bivalirudin is more effective and safer than heparin monotherapy and should therefore be preferred over heparin monotherapy.</p>
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<author><name sortKey="Hamm, C" uniqKey="Hamm C">C Hamm</name>
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<author><name sortKey="Dill, T" uniqKey="Dill T">T Dill</name>
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<author><name sortKey="Ten Berg, J" uniqKey="Ten Berg J">J Ten Berg</name>
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<author><name sortKey="Heestermans, T" uniqKey="Heestermans T">T Heestermans</name>
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<author><name sortKey="Grines, Cl" uniqKey="Grines C">CL Grines</name>
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<author><name sortKey="Clayton, T" uniqKey="Clayton T">T Clayton</name>
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<author><name sortKey="Deliagyris, M" uniqKey="Deliagyris M">M Deliagyris</name>
</author>
<author><name sortKey="Prats, J" uniqKey="Prats J">J Prats</name>
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<author><name sortKey="Kastrati, A" uniqKey="Kastrati A">A Kastrati</name>
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<author><name sortKey="Schulz, S" uniqKey="Schulz S">S Schulz</name>
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<author><name sortKey="Grines, Cl" uniqKey="Grines C">CL Grines</name>
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<author><name sortKey="Barragan, P" uniqKey="Barragan P">P Barragan</name>
</author>
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<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>France</li>
<li>Inde</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
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<tree><country name="Royaume-Uni"><noRegion><name sortKey="Kinnaird, Tim" sort="Kinnaird, Tim" uniqKey="Kinnaird T" first="Tim" last="Kinnaird">Tim Kinnaird</name>
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<name sortKey="Eijgelshoven, Indra" sort="Eijgelshoven, Indra" uniqKey="Eijgelshoven I" first="Indra" last="Eijgelshoven">Indra Eijgelshoven</name>
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</noRegion>
</country>
<country name="Inde"><noRegion><name sortKey="Kaul, Upendra" sort="Kaul, Upendra" uniqKey="Kaul U" first="Upendra" last="Kaul">Upendra Kaul</name>
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<country name="Allemagne"><noRegion><name sortKey="Radke, Peter W" sort="Radke, Peter W" uniqKey="Radke P" first="Peter W" last="Radke">Peter W. Radke</name>
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<country name="Australie"><noRegion><name sortKey="Chew, Derek P" sort="Chew, Derek P" uniqKey="Chew D" first="Derek P" last="Chew">Derek P. Chew</name>
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</record>
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