Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Sep 2015
Editorial Review Meta AnalysisShort- and long-term outcomes in diabetes patients undergoing percutaneous coronary intervention with bivalirudin compared with heparin and glycoprotein IIb/IIIA inhibitors: A meta-analysis of randomized trials.
Diabetes patients undergoing percutaneous coronary intervention (PCI) have more complications than nondiabetes patients, including increased long-term mortality. Use of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitors (GPI) in diabetes patients undergoing PCI and its effect on long-term mortality were evaluated in few randomized trials, but with conflicting results. ⋯ Among patients with diabetes undergoing PCI, bivalirudin caused less major and minor bleeding compared with heparin and GPI, with similar rates of MACE, death, MI, and urgent revascularization at 30 days, but significantly lower mortality rates at 1 year.
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Catheter Cardiovasc Interv · Sep 2015
Meta AnalysisBivalirudin versus heparin in patients with acute myocardial infarction: A meta-analysis of randomized trials.
The aim of this study was to assess the impact of bivalirudin, as compared to unfractionated heparin, on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). ⋯ In patients with STEMI, bivalirudin, as compared to heparin, increases the risk of stent thrombosis and ischemia driven repeat revascularization at 30 days. There is no strong evidence that bivalirudin significantly reduces major bleeding at 30 days. Bivalirudin does not have an effect on all-cause mortality at 30 days.
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Bleeding rates with unfractionated heparin (UH) without concomitant use of glycoprotein IIb/IIIa inhibitors as compared to bivalirudin are similar. Ischemic event rates during the index hospitalization are similar in the heparin and bivalirudin subgroups. Low does heparin (60-70 units/kg) with a target ACT of 200-250 sec may obviate the historical improved safety of bivalirudin demonstrated in certain clinical trials.