{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:50:30Z","timestamp":1793749830574,"version":"4.6.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>Data on outcomes between unfractionated heparin and bivalirudin anticoagulation during percutaneous coronary intervention (PCI) in acute coronary syndromes remain inconclusive. We aimed to systematically analyze PCI outcomes by comparing unfractionated heparin and bivalirudin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We systematically searched Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception in 1966 through January 2024 for studies evaluating PCI outcomes comparing unfractionated heparin and bivalirudin. Two investigators independently reviewed the data. Conflicts were resolved through consensus. Random-effects meta-analyses were used.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 10 prospective trials were identified that enrolled 42,253 individuals who presented with an acute coronary syndrome. Our analysis found that heparin when compared to bivalirudin was associated with an increased risk of trial-based definition of major bleeding [relative risk (RR): 1.68, 95% confidence interval (CI): 1.29\u20132.20], nonaccess site complications (RR: 4.6, 95% CI: 1.75\u201312.09), thrombolysis in myocardial infarction major bleeding (RR: 1.70, 95% CI: 1.20\u20132.41), major bleeding risks (RR: 1.87, 95% CI: 1.49\u20132.36), cardiovascular disease death (RR: 1.26, 95% CI: 1.02\u20131.57), and thrombocytopenia (RR: 1.67, 95% CI: 1.07\u20132.62). There were no statistically significant differences between heparin and bivalirudin for all-cause mortality, major adverse cardiovascular event, stroke, reinfarction, target vessel revascularization, and acute or stent thrombosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The present meta-analysis demonstrates bivalirudin reduces major bleeding when used for anticoagulation during PCI in patients with acute coronary syndromes and is not associated with an increased risk of stent thrombosis or major adverse cardiovascular event.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/hpc.0000000000000372","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:12:00Z","timestamp":1740157920000},"page":"e0372","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Bivalirudin Versus Heparin in Patients Undergoing Percutaneous Coronary Intervention in Acute Coronary Syndromes"],"prefix":"10.1097","volume":"24","author":[{"given":"Chayakrit","family":"Krittanawong","sequence":"first","affiliation":[{"name":"Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Ahuja","sequence":"additional","affiliation":[{"name":"NYU Langone Health, Department of Pharmacy, NYU Grossman School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Health Science Services, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN"},{"name":"Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf Kamran","family":"Qadeer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Errol","family":"Moras","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafeez Ul Hassan","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahboob","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Texas Heart Institute, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Jneid","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Cardiology, University of Texas Medical Branch, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samin","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"R1-20250221","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/S0140-6736(09)61484-7","article-title":"Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trial.","volume":"374","author":"Mehran","year":"2009","journal-title":"Lancet"},{"key":"R2-20250221","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1056\/NEJMoa1706443","article-title":"Bivalirudin versus heparin monotherapy in myocardial infarction.","volume":"377","author":"Erlinge","year":"2017","journal-title":"N Engl J Med"},{"key":"R3-20250221","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1016\/S0140-6736(22)01999-7","article-title":"Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial.","volume":"400","author":"Li","year":"2022","journal-title":"Lancet"},{"key":"R5-20250221","first-page":"e4","article-title":"2021 ACC\/AHA\/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"145","author":"Lawton","year":"2022","journal-title":"Circulation"},{"key":"R6-20250221","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/jama.289.7.853","article-title":"Bivalirudin and provisional glycoprotein IIb\/IIIa blockade compared with heparin and planned glycoprotein IIb\/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial.","volume":"289","author":"Lincoff","year":"2003","journal-title":"JAMA"},{"key":"R7-20250221","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1056\/NEJMoa062437","article-title":"Bivalirudin for patients with acute coronary syndromes.","volume":"355","author":"Stone","year":"2006","journal-title":"N Engl J Med"},{"key":"R8-20250221","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1056\/NEJMoa0708191","article-title":"Bivalirudin during primary PCI in acute myocardial infarction.","volume":"358","author":"Stone","year":"2008","journal-title":"N Engl J Med"},{"key":"R9-20250221","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1001\/jamacardio.2016.5975","article-title":"One-year mortality for bivalirudin vs heparins plus optional glycoprotein IIb\/IIIa inhibitor treatment started in the ambulance for ST-segment elevation myocardial infarction: a secondary analysis of the EUROMAX randomized clinical trial.","volume":"2","author":"Fabris","year":"2017","journal-title":"JAMA Cardiol"},{"key":"R10-20250221","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/S0140-6736(14)60924-7","article-title":"Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial.","volume":"384","author":"Shahzad","year":"2014","journal-title":"Lancet"},{"key":"R11-20250221","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1001\/jama.2015.2323","article-title":"Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial.","volume":"313","author":"Han","year":"2015","journal-title":"JAMA"},{"key":"R12-20250221","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1056\/NEJMoa1507854","article-title":"Bivalirudin or unfractionated heparin in acute coronary syndromes.","volume":"373","author":"Valgimigli","year":"2015","journal-title":"N Engl J Med"},{"key":"R13-20250221","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0140-6736(18)31714-8","article-title":"Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial.","volume":"392","author":"Valgimigli","year":"2018","journal-title":"Lancet"},{"key":"R14-20250221","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1161\/CIRCULATIONAHA.123.063946","article-title":"Bivalirudin versus heparin during PCI in NSTEMI: individual patient data meta-analysis of large randomized trials.","volume":"148","author":"Bikdeli","year":"2023","journal-title":"Circulation"},{"key":"R15-20250221","doi-asserted-by":"crossref","first-page":"e19064","DOI":"10.1097\/MD.0000000000019064","article-title":"Efficacy and safety of bivalirudin vs heparin in patients with coronary heart disease undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials.","volume":"99","author":"Liu","year":"2020","journal-title":"Medicine (Baltim)"},{"key":"R16-20250221","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4244\/EIJY14M08_01","article-title":"Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: a meta-analysis of randomised trials.","volume":"11","author":"Cassese","year":"2015","journal-title":"EuroIntervention"}],"container-title":["Critical Pathways in Cardiology: A Journal of Evidence-Based 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