"Combined Use of Bivalirudin and Radial Access in Acute Coronary Syndro" by George S. Mina, George F. Gobrial et al.

Faculty Publications

Title

Combined Use of Bivalirudin and Radial Access in Acute Coronary Syndromes Is Not Superior to the Use of Either One Separately: Meta-Analysis of Randomized Controlled Trials

Authors

George S. Mina, Department of Cardiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana.
George F. Gobrial, Department of Cardiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana.
Kalgi Modi, Department of Cardiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana.
Paari Dominic, Department of Cardiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana. Electronic address: pdomi2@lsuhsc.edu.

Document Type

Article

Publication Date

8-8-2016

Abstract

OBJECTIVES: The aim of this meta-analysis was to study the relation between access site and bivalirudin use on outcomes in patients with acute coronary syndrome (ACS). BACKGROUND: Bivalirudin and radial access use are 2 strategies that are increasingly used to lower major bleeding in patients with ACS undergoing invasive approaches. The interaction between these 2 strategies and the benefit of using them in combination are unclear. METHODS: This analysis included randomized controlled trials that compared bivalirudin to heparin with or without glycoprotein IIb/IIIa inhibitors in patients with ACS and reported outcomes stratified by arterial access site. Meta-analyses of outcome data were performed on the basis of access site and anticoagulation regimen. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from event rates using random-effects models. RESULTS: Eight trials with a total of 27,491 patients were included. Bivalirudin reduced major bleeding risk in patients with femoral access (OR: 0.51; 95% CI: 0.46 to 0.6; p < 0.001) but not in patients with radial access (OR: 0.75; 95% CI: 0.45 to 1.26; p = 0.28). Moreover, radial access reduced major bleeding risk in patients treated with heparin (OR: 0.57; 95% CI: 0.43 to 0.77; p < 0.001) but not in patients treated with bivalirudin (OR: 0.96; 95% CI: 0.65 to 1.41; p = 0.83). There were no differences in major adverse cardiovascular events or all-cause mortality between bivalirudin and heparin, regardless of access site. CONCLUSIONS: Bivalirudin reduces bleeding risk only with femoral access, and radial access reduces bleeding risk only with heparin anticoagulation. Therefore, there is no additional benefit to the combined use of bivalirudin and radial access strategies in patients with ACS.

Publication Source (Journal or Book title)

JACC. Cardiovascular interventions

First Page

1523

Last Page

Recommended Citation

Mina, G. S., Gobrial, G. F., Modi, K., & Dominic, P. (2016). Combined Use of Bivalirudin and Radial Access in Acute Coronary Syndromes Is Not Superior to the Use of Either One Separately: Meta-Analysis of Randomized Controlled Trials. JACC. Cardiovascular interventions, 9 (15), 1523-31. https://doi.org/10.1016/j.jcin.2016.05.023

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