• Eliano Pio Navarese, Volker Schulze, Felicita Andreotti, Mariusz Kowalewski, Michalina Kołodziejczak, David E Kandzari, Tienush Rassaf, Bartosz Gorny, Maximilian Brockmeyer, Christian Meyer, Sergio Berti, Jacek Kubica, Malte Kelm, and Marco Valgimigli.
• Invasive Cardiology, National Research Council Institute of Clinical Physiology, Pisa, Italy; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Poland and Germany. Electronic address: eliano.navarese@alice.it.
• JACC Cardiovasc Interv. 2015 Jan 1;8(1 Pt B):201-13.

ObjectivesThe aim of this meta-analysis was to compare the 30-day safety and efficacy of bivalirudin with those of heparin with or without routine administration of a glycoprotein IIb/IIIa inhibitor (GPI) in patients with acute coronary syndrome (ACS).BackgroundBivalirudin has been a mainstay of anticoagulation in patients with ACS compared with heparin. The extent to which trial results have been affected by the coadministration of heparin with a GPI, however, remains unclear.MethodsA total of 13 randomized, controlled trials involving 24,605 patients were included.ResultsThere was no significant difference in 30-day mortality or myocardial infarction rate with bivalirudin compared with heparin with or without routine GPI administration. A reduction of 30-day major bleeding was observed with bivalirudin compared with heparin that was significant when GPI was routinely administered (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.45 to 0.60), p < 0.001) but not with provisionally administered GPI (OR: 0.66, 95% CI: 0.33 to 1.32; p = 0.24). The occurrence of stent thrombosis (ST) at 30 days was significantly increased with bivalirudin compared with heparin plus routinely administered GPI (OR: 1.67, 95% CI: 1.13 to 2.45, p = 0.02), but not compared with heparin plus provisionally administered GPI (OR: 2.08, 95% CI: 0.35 to 12.32, p = 0.42). The rate of acute ST (≤ 24 h), however, was almost 4.5-fold higher with bivalirudin compared with heparin with or without GPI, whereas the rate of subacute ST (24 h to 30 days) did not differ significantly.ConclusionsOverall, bivalirudin in ACS patients is associated with a significant reduction of major bleeding compared with heparin plus routinely administered GPI, but with a marked increase in ST rates compared with heparin with or without GPI.Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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