Abstract 15709: Bivalirudin is Associated With Decreased Cardiovascular Outcomes and Bleeding as Compared to Heparin During PCI: A Meta- Analysis

Abstract

Background: Anticoagulant therapy is needed for safe and effective Percutaneous Coronary Intervention (PCI). Bivalirudin is widely used as an anticoagulant during PCI in acute coronary syndromes. Prior analysis had shown significant decrease in bleeding with similar rates of death with Bivalirudin compared to Heparin. Recent studies have shown mixed results. We performed this meta-analysis to compare the effect of bivalirudin versus heparin on major bleeding and deaths after PCI. Methods: We performed a systematic literature search for studies comparing bivalirudin versus heparin on major bleeding and deaths after PCI. Studies providing data on the outcome of major bleeding and deaths were included. Statistical heterogeneity across the various trials was tested using the Cochran’s Q statistic and I2 was computed to quantify heterogeneity. A two-sided alpha error of less than 0.05 was considered to be statistically significant (p < 0.05). Results: Total of 22 eligible studies was included for major bleeding events and total 24 eligible studies were included for death events. The studies for major bleeding events were heterogeneous while studies for death events were homogenous; hence random and fixed effect model was used respectively to calculate combined relative risk (RR). Meta-analysis revealed that the use of bivalirudin compared to heparin is associated with statistically significant lower rates of major bleeding (RR, 0.612; CI, 0.504 to 0.742; p = 0.000) and death (RR, 0.709; CI, 0.606 to 0.830; p = 0.000). Conclusion: Our analysis concluded that bivalirudin compared to heparin is associated with lower rates of major bleeding and death during PCI.