Assessing the Impact of Using Heparin and Bivalirudin on  Clinical Outcome of Subjects Undergoing Percutaneous  Coronary Intervention: A Meta-Analysis

Yan  Yu; Xiaojian  Sun; Mengchao  Su

doi:10.18502/ijph.v54i12.20812

Yan Yu Department of Cardiac Intensive Care Unit, Yantai YuHuangDing Hospital, Yantai, Shandong, China
Xiaojian Sun Department of Cardiac Intensive Care Unit, Yantai YuHuangDing Hospital, Yantai, Shandong, China
Mengchao Su Department of Cardiac Intensive Care Unit, Yantai YuHuangDing Hospital, Yantai, Shandong, China

DOI: https://doi.org/10.18502/ijph.v54i12.20812

Keywords: Heparin; Bivalirudin; Percutaneous coronary intervention

Abstract

Background: Bivalirudin is increasingly used as an alternative to heparin in patients undergoing percutaneous coronary intervention (PCI) due to its potential for reducing adverse clinical outcomes. This meta-analysis aimed to compare the effectiveness and safety of bivalirudin versus heparin across various clinical outcomes.

Method: A total of 27 studies were included, comprising 63,624 patients: 30,492 received Bivalirudin, and 33,132 received Heparin. Key endpoints analyzed include net adverse clinical events (NACE), major adverse clinical events, major bleeding, mortality, stroke, and stent thrombosis. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using Begg’s and Egger’s tests.

Results: Bivalirudin significantly reduced the risk of major bleeding (MD=-0.4445, 95% CI [-0.6276, -0.2615], P<0.0001, I²=76.79%) compared to Heparin. However, no significant differences were found for major adverse clinical events (MD=-0.0993, P=0.3194) or mortality (MD=-0.1959, P=0.0893). There was moderate heterogeneity in most analyses, particularly for NACE (I²=68.24%) and stent thrombosis (I²=55.33%). No significant differences were observed for stroke prevention or stent thrombosis. Subgroup analyses demonstrated significant reductions in major bleeding with Bivalirudin, particularly in STEMI patients (log OR=-0.37, P<0.0001), though no differences in MACE or stent thrombosis were observed. High heterogeneity in NSTEMI populations (I²=81.4%) underscores the need for individualized therapy.

Conclusion: Although bivalirudin significantly lowers major bleeding compared with Heparin, it shows no clear advantage in mortality or other major clinical outcomes. Substantial heterogeneity across studies indicates variability in patient populations and procedural settings. Further research is needed to define its optimal role in specific PCI subgroups.