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Chai L, Liu J, Zhang Y, Zhang M, Wang Z, Wu Y, Bai Z, Qin Z. Comparison of net adverse clinical events between bivalirudin and heparin as anticoagulants for percutaneous coronary intervention in Chinese patients. Exp Ther Med 2023; 26:530. [PMID: 37869647 PMCID: PMC10587863 DOI: 10.3892/etm.2023.12229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
Bivalirudin, as a direct thrombin inhibitor, is considered to be safer compared with other anticoagulants, such as heparin; however, relevant data in China are unclear. The present study aimed to compare the safety of bivalirudin and heparin as anticoagulants in Chinese patients who underwent percutaneous coronary intervention (PCI). In the present study, 2,377 patients with ST-segment elevation myocardial infarction (STEMI), unstable angina, non-STEMI or stable coronary artery disease who underwent primary PCI while receiving bivalirudin or heparin (low molecular weight heparin or unfractionated heparin) were reviewed, and then analyzed as the bivalirudin group (n=944) and heparin group (n=1,433). The net adverse clinical events (NACEs) within 30 days were obtained, which were defined as major adverse cardiac and cerebral events (MACCEs) + Bleeding Academic Research Consortium (BARC) grade 2-5 bleeding events. Compared with the heparin group, the incidence of NACEs was reduced in the bivalirudin group (9.3 vs. 13.4%; P=0.003). However, no discrepancy was found in the incidence of MACCEs between the groups (5.9 vs. 7.6%; P=0.116). Moreover, the incidences of BARC 2-5 (4.8 vs. 8.7%; P<0.001) and BARC 3-5 bleeding events (1.9 vs. 4.4%; P=0.001) were decreased in the bivalirudin group compared with the heparin group. Following adjustment using multivariate logistic regression analysis, bivalirudin treatment (vs. heparin treatment) was independently associated with lower risks of NACEs [odds ratio (OR), 0.587; P<0.001], MACCEs (OR, 0.689; P=0.041) and BARC 2-5 (OR, 0.459; P<0.001) and 3-5 bleeding events (OR, 0.386; P=0.002). Overall, the present study demonstrated that bivalirudin decreased the risks of NACEs and bleeding events compared with heparin in Chinese patients who undergo PCI. However, further validation is required.
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Affiliation(s)
- Lina Chai
- Department of Cardiology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Jinjun Liu
- Department of Cardiology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Yapei Zhang
- The Fourth Department of Oncology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Mengying Zhang
- Department of Cardiology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Zhenzhen Wang
- Department of Cardiology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Yiping Wu
- Department of Neurology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Zhichao Bai
- Department of Cardiology, Handan Central Hospital, Handan, Hebei 056002, P.R. China
| | - Zhenpeng Qin
- Veteran Cadre Management Section, Handan Central Hospital, Handan, Hebei 056002, P.R. China
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Li J, Chen S, Ma S, Yang M, Qi Z, Na K, Qiu M, Li Y, Han Y. Safety and Efficacy of Bivalirudin versus Unfractionated Heparin Monotherapy in Patients with CAD and DM Undergoing PCI: A Retrospective Observational Study. Cardiovasc Ther 2022; 2022:5352087. [PMID: 36530956 PMCID: PMC9729030 DOI: 10.1155/2022/5352087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 10/24/2023] Open
Abstract
Introduction Optimal anticoagulants for patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) are unclear. This retrospective observational study is aimed at evaluating efficacy and safety of bivalirudin versus unfractionated heparin (UFH) monotherapy in patients with DM undergoing PCI. Methods A total of 3890 diabetic patients receiving PCI in the General Hospital of Northern Theater Command were divided into the bivalirudin group (n = 869) and the UFH group (n = 3021) according to different anticoagulant therapy regimens. Indication for PCI was in accordance with current guidelines including national cardiovascular data registry. The primary endpoint was 30-day net adverse clinical events (NACEs). The secondary endpoints included 30-day major adverse cardiac and cerebral events (MACCEs), bleeding events defined according to the Bleeding Academic Research Consortium (BARC) definition, and stent thrombosis (ST). Patients were matched by propensity score at a ratio of 1 : 1. Results After propensity score matching, the bivalirudin group was associated with a lower incidence of NACEs (3.0% vs. 6.0%, P = 0.003) than the UFH group. The incidence of MACCE (1.7% vs. 3.3%, P = 0.033) was significantly lower in the bivalirudin group, mainly due to a lower mortality rate (0.6% vs. 2.0%, P = 0.010). In addition, patients in the bivalirudin group had less bleeding (1.4% vs. 3.0%, P = 0.022) than those in the UFH group, although BARC 2, 3, and 5 bleeding (0.1% vs. 0.6%, P = 0.218) was numerically lower. Conclusion In diabetic patients undergoing PCI, bivalirudin was significantly associated with reduced risks of 30-day NACE and MACCE, mainly driven by the lower rates of bleeding and mortality, compared with heparin monotherapy.
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Affiliation(s)
- Jing Li
- The Graduate School of Harbin Medical University, Harbin, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Sanbao Chen
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Sicong Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Mingque Yang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Zizhao Qi
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Kun Na
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Miaohan Qiu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Yaling Han
- The Graduate School of Harbin Medical University, Harbin, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
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Mousavi S, Moradi M, Khorshidahmad T, Motamedi M. Anti-Inflammatory Effects of Heparin and Its Derivatives: A Systematic Review. Adv Pharmacol Sci 2015; 2015:507151. [PMID: 26064103 PMCID: PMC4443644 DOI: 10.1155/2015/507151] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/24/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Heparin, used clinically as an anticoagulant, also has anti-inflammatory properties. The purpose of this systematic review was to provide a comprehensive review regarding the efficacy and safety of heparin and its derivatives as anti-inflammatory agents. Methods. We searched the following databases up to March 2012: Pub Med, Scopus, Web of Science, Ovid, Elsevier, and Google Scholar using combination of Mesh terms. Randomized Clinical Trials (RCTs) and trials with quasi-experimental design in clinical setting published in English were included. Quality assessments of RCTs were performed using Jadad score and Consolidated Standards of Reporting Trials (CONSORT) checklist. Results. A total of 280 relevant studies were reviewed and 57 studies met the inclusion criteria. Among them 48 studies were RCTs. About 65% of articles had score of 3 and higher according to Jadad score. Twelve studies had a quality score > 40% according to CONSORT items. Asthma (n = 7), inflammatory bowel disease (n = 5), cardiopulmonary bypass (n = 8), and cataract surgery (n = 6) were the most studied disease condition. Forty studies use unfractionated heparin (UFH) for intervention; the remaining studies use low molecular weight heparin (LMWH). Conclusion. Despite the conflicting results, heparin seems to be a safe and effective anti-inflammatory agent; although it is shown that heparin can decrease the level of inflammatory biomarkers and improves patient conditions, still more data from larger rigorously designed studies are needed to support use of heparin as an anti-inflammatory agent in clinical setting. However, because of the association between inflammation, atherogenesis, thrombogenesis, and cell proliferation, heparin and related compounds with pleiotropic effects may have greater therapeutic efficacy than compounds acting against a single target.
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Affiliation(s)
- Sarah Mousavi
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mandana Moradi
- Faculty of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Tina Khorshidahmad
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Motamedi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Palmerini T, Brener SJ, Mehran R, Dangas G, Genereux P, Riva DD, Mariani A, Xu K, Stone GW. Leukocyte Count Is a Modulating Factor for the Mortality Benefit of Bivalirudin in ST-Segment–Elevation Acute Myocardial Infarction. Circ Cardiovasc Interv 2013; 6:518-26. [DOI: 10.1161/circinterventions.113.000592] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tullio Palmerini
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Sorin J. Brener
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Roxana Mehran
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - George Dangas
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Philippe Genereux
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Diego Della Riva
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Andrea Mariani
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Ke Xu
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
| | - Gregg W. Stone
- From the Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna, Italy (T.P., D.D.R., A.M.); Weill Cornell Medical College, New York Methodist Hospital, New York, NY (S.J.B.); The Cardiovascular Institute, Mount Sinai Medical Center, New York, NY (R.M., G.D.); Cardiovascular Department, Columbia University Medical Center, New York, NY (P.G., K.X., G.W.S.); the Cardiovascular Research Foundation, New York, NY (P.G., K.X., G.W.S.); and Hôpital du Sacré-Coeur de Montréal, Université de Montréal,
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Feit F, Manoukian SV, Ebrahimi R, Pollack CV, Ohman EM, Attubato MJ, Mehran R, Stone GW. Safety and efficacy of bivalirudin monotherapy in patients with diabetes mellitus and acute coronary syndromes: a report from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol 2008; 51:1645-52. [PMID: 18436116 DOI: 10.1016/j.jacc.2007.11.081] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 11/05/2007] [Accepted: 11/13/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to evaluate clinical outcomes of patients with diabetes mellitus in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, overall and by treatment arm. BACKGROUND In the ACUITY trial, 13,819 patients with moderate- or high-risk acute coronary syndromes (ACS) were randomized to heparin (unfractionated or enoxaparin) plus glycoprotein IIb/IIIa inhibition (GPI), bivalirudin plus GPI, or bivalirudin monotherapy. Compared with heparin plus GPI, bivalirudin monotherapy resulted in similar protection from ischemic events with less major bleeding. Whether these results apply to patients with diabetes is unknown. METHODS We evaluated the impact of diabetes on 30-day net adverse clinical outcomes (composite ischemia [death, myocardial infarction, or unplanned ischemic revascularization] or major bleeding), overall and by antithrombotic strategy. RESULTS Diabetes was present in 3,852 randomized patients (27.9%). Compared with nondiabetic patients, diabetic patients had higher 30-day rates of net adverse clinical outcomes (12.9% vs. 10.6%; p < 0.001), composite ischemia (8.7% vs. 7.2%; p = 0.003), and major bleeding (5.7% vs. 4.2%; p < 0.001). Among diabetic patients, compared with heparin plus GPI, bivalirudin plus GPI resulted in similar rates of net adverse clinical outcomes (14.0% vs. 13.8%; p = 0.89), while bivalirudin monotherapy resulted in a similar rate of composite ischemia (7.9% vs. 8.9%; p = 0.39) and less major bleeding (3.7% vs. 7.1%; p < 0.001), yielding fewer net adverse clinical outcomes (10.9% vs. 13.8%; p = 0.02). CONCLUSIONS Diabetic patients with ACS managed invasively have higher rates of composite ischemia and major bleeding. Compared with treatment with heparin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding, resulting in a significant reduction in net adverse clinical outcomes.
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Affiliation(s)
- Frederick Feit
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
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