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Efficacy and safety of bivalirudin versus heparin in patients with diabetes mellitus undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials.

Abstract The efficacy and safety of bivalirudin (Biva) versus heparin in patients with diabetes mellitus (DM) who undergo percutaneous coronary intervention (PCI) remain controversial. Our meta-analysis was undertaken to evaluate the efficacy and safety of Biva compared with those of heparin in patients with diabetes undergoing PCI.
PMID
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Authors

Mayor MeshTerms

Diabetes Mellitus

Percutaneous Coronary Intervention

Keywords
Journal Title medicine
Publication Year Start




PMID- 28723739
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170728
LR  - 20170801
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 29
DP  - 2017 Jul
TI  - Efficacy and safety of bivalirudin versus heparin in patients with diabetes
      mellitus undergoing percutaneous coronary intervention: A meta-analysis of
      randomized controlled trials.
PG  - e7204
LID - 10.1097/MD.0000000000007204 [doi]
AB  - BACKGROUND: The efficacy and safety of bivalirudin (Biva) versus heparin in
      patients with diabetes mellitus (DM) who undergo percutaneous coronary
      intervention (PCI) remain controversial. Our meta-analysis was undertaken to
      evaluate the efficacy and safety of Biva compared with those of heparin in
      patients with diabetes undergoing PCI. METHODS: We searched PubMed, EMBASE,
      Cochrane Library, and Clinical Trials.gov databases for randomized controlled
      trials (RCTs). The primary efficacy endpoint was the incidence of major adverse
      cardiovascular events (MACE), and the primary safety endpoint was the incidence
      of major bleeding. Secondary efficacy endpoints were incidence of net adverse
      clinical events (NACE), myocardial infarction (MI), and death. The pooled risk
      ratio (RR) with the corresponding 95% confidence intervals (CIs) were used to
      assess the efficacy and safety of Biva versus heparin. RESULTS: Eleven RCTs met
      the inclusion criteria, and 8428 patients were included. No significant
      difference was observed in the subgroup and overall risk of MACE (RR 0.87; 95% CI
      0.74-1.02; P = .08; I = 39%) and NACE (RR 0.81; 95% CI 0.61-1.07; P = .14; I =
      71%). Biva had an effect similar to that of heparin on the endpoint of death (RR 
      0.75; 95% CI 0.56-1.02; P = .07; I = 0) and MI (RR 0.92; 95% CI 0.67-1.26; P =
      .59; I = 0) but decreased the risk of major bleeding (RR 0.63; 95% CI 0.52-0.75; 
      P < .00001; I = 0%). CONCLUSION: The use of Biva and heparin is associated with a
      similar risk of MACE, NACE, death, and MI. Biva decreases the risk of major
      bleeding more significantly than heparin.
FAU - Zhang, Juan
AU  - Zhang J
AD  - Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, 
      Beijing, China.
FAU - Yang, Xinchun
AU  - Yang X
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - AIM
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - *Diabetes Mellitus
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - *Percutaneous Coronary Intervention
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/adverse effects/therapeutic use
PMC - PMC5521879
EDAT- 2017/07/21 06:00
MHDA- 2017/07/29 06:00
CRDT- 2017/07/21 06:00
AID - 10.1097/MD.0000000000007204 [doi]
AID - 00005792-201707210-00004 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(29):e7204. doi: 10.1097/MD.0000000000007204.