Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis

Wilman Olmedo, Pedro A. Villablanca, Cristina Sanina, Jonathan Walker, Michael Weinreich, Jeannine Brevik, Ricardo Avendano, Claudio A. Bravo, Jorge Romero, Harish Ramakrishna, Anvar Babaev, Michael Attubato, D. F. Hernandez-Suarez, P. Cox-Alomar, Robert Pyo, Prakash Krishnan, Jose Wiley

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05). Conclusion: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

Original languageEnglish (US)
Pages (from-to)78-89
Number of pages12
JournalVascular
Volume27
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Heparin
Meta-Analysis
Odds Ratio
Hemorrhage
Anticoagulants
Mortality
bivalirudin
Amputation
PubMed
Blood Transfusion
Stroke
Myocardial Infarction
Safety

Keywords

  • access site complications
  • Bivalirudin
  • bleeding
  • heparin
  • mortality
  • peripheral percutaneous interventions

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Olmedo, W., Villablanca, P. A., Sanina, C., Walker, J., Weinreich, M., Brevik, J., ... Wiley, J. (2019). Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis. Vascular, 27(1), 78-89. https://doi.org/10.1177/1708538118807522

Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions : A systematic review and meta-analysis. / Olmedo, Wilman; Villablanca, Pedro A.; Sanina, Cristina; Walker, Jonathan; Weinreich, Michael; Brevik, Jeannine; Avendano, Ricardo; Bravo, Claudio A.; Romero, Jorge; Ramakrishna, Harish; Babaev, Anvar; Attubato, Michael; Hernandez-Suarez, D. F.; Cox-Alomar, P.; Pyo, Robert; Krishnan, Prakash; Wiley, Jose.

In: Vascular, Vol. 27, No. 1, 01.02.2019, p. 78-89.

Research output: Contribution to journalArticle

Olmedo, W, Villablanca, PA, Sanina, C, Walker, J, Weinreich, M, Brevik, J, Avendano, R, Bravo, CA, Romero, J, Ramakrishna, H, Babaev, A, Attubato, M, Hernandez-Suarez, DF, Cox-Alomar, P, Pyo, R, Krishnan, P & Wiley, J 2019, 'Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions: A systematic review and meta-analysis', Vascular, vol. 27, no. 1, pp. 78-89. https://doi.org/10.1177/1708538118807522
Olmedo, Wilman ; Villablanca, Pedro A. ; Sanina, Cristina ; Walker, Jonathan ; Weinreich, Michael ; Brevik, Jeannine ; Avendano, Ricardo ; Bravo, Claudio A. ; Romero, Jorge ; Ramakrishna, Harish ; Babaev, Anvar ; Attubato, Michael ; Hernandez-Suarez, D. F. ; Cox-Alomar, P. ; Pyo, Robert ; Krishnan, Prakash ; Wiley, Jose. / Bivalirudin versus heparin in patients undergoing percutaneous peripheral interventions : A systematic review and meta-analysis. In: Vascular. 2019 ; Vol. 27, No. 1. pp. 78-89.
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T2 - A systematic review and meta-analysis

AU - Olmedo, Wilman

AU - Villablanca, Pedro A.

AU - Sanina, Cristina

AU - Walker, Jonathan

AU - Weinreich, Michael

AU - Brevik, Jeannine

AU - Avendano, Ricardo

AU - Bravo, Claudio A.

AU - Romero, Jorge

AU - Ramakrishna, Harish

AU - Babaev, Anvar

AU - Attubato, Michael

AU - Hernandez-Suarez, D. F.

AU - Cox-Alomar, P.

AU - Pyo, Robert

AU - Krishnan, Prakash

AU - Wiley, Jose

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N2 - Background: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05). Conclusion: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

AB - Background: Bivalirudin may be an effective alternative anticoagulant to heparin for use in percutaneous peripheral interventions. We aimed to compare the safety and efficacy of bivalirudin versus heparin as the procedural anticoagulant agent in patients undergoing percutaneous peripheral intervention. Methods: For this meta-analysis and systematic review, we conducted a search in PubMed, Medline, Embase, and Cochrane for all the clinical studies in which bivalirudin was compared to heparin as the procedural anticoagulant in percutaneous peripheral interventions. Outcomes studied included all-cause mortality, all-bleeding, major and minor bleeding, and access site complications. Results: Eleven studies were included in the analysis, totaling 20,137 patients. There was a significant difference favoring bivalirudin over heparin for all-cause mortality (risk ratio 0.58, 95% CI 0.39–0.87), all-bleeding (risk ratio 0.62, 95% CI 0.50–0.78), major bleeding (risk ratio 0.61, 95% CI 0.39–0.96), minor bleeding (risk ratio 0.66, 95% CI 0.47–0.92), and access site complications (risk ratio 0.66, 95% CI 0.51–0.84). There was no significant difference in peri-procedural need for blood transfusions (risk ratio 0.79, 95% CI 0.57–1.08), myocardial infarction (risk ratio 0.87, 95% CI 0.59–1.28), stroke (risk ratio 0.77, 95% CI 0.59–1.01), intracranial bleeding (risk ratio 0.77, 95% CI 0.29–2.02), or amputations (OR 0.75, 95% CI 0.53–1.05). Conclusion: Our meta-analysis suggests that bivalirudin use for percutaneous peripheral interventions is associated with lower all-cause mortality, bleeding, and access site complications as compared to heparin. Further large randomized trials are needed to confirm the current results.

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KW - heparin

KW - mortality

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