Abstract 13350: Bivalirudin versus Heparin in Patients With Myocardial Infarction, an Updated Meta-Analysis

Abstract

Bivalirudin and heparin are anticoagulant drugs commonly used in patients with acute myocardial infarction who undergo percutaneous coronary intervention (PCI). We performed this meta-analysis to update the present evidence about the safety and efficacy of bivalirudin versus heparin in myocardial infarction patients who underwent PCI. We searched PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Scopus for relevant randomized controlled trials (RCTs) from inception until 1 April 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as the risk ratios (RR) with the corresponding 95% confidence intervals (CI) in the meta-analysis models using Review Manager (RevMan version 5.4). Pooling data from 9 RCTs (20,036 patients) showed that bivalirudin was superior to heparin in terms of adverse major cardiovascular and cerebrovascular events (MACE) (RR 0.78, 95% CI 0.62 to 0.99, P=0.04) and stent thrombosis (RR 0.73, 95% CI 0.60 to 0.89, P=0.002). However, the overall effect did not favor either of the two groups in terms of all-cause death (RR 1.09, 95% CI 0.90 to 1.30, P=0.37), myocardial infarction (RR 0.87, 95% CI 0.71 to 1.07, P=0.2), stroke (RR 1.09, 95% CI 0.77 to 1.54, P=0.6), bleeding (RR 0.97, 95% CI 0.88 to 1.07, P=0.5), and Bleeding Academic Research Consortium (BARC) scale type 2 (RR 0.93, 95% CI 0.82 to 1.06, P=0.3). Ultimately, the current evidence suggests that bivalirudin appears to be an effective alternative to heparin for anticoagulation during PCI in myocardial infarction patients in terms of MACE and stent thrombosis. Further research is needed to determine the optimal anticoagulation strategy.