| ABSTRACT Objective:To evaluate the efficacy and safety of the bivalirudin versus heparin in patients undergoing percutaneous coronary intervention (PCI) by Meta analysis. Methods:PubMed, The Cochrane Library, Embase, Clinical Trials.gov, CNKI, WanFang Data, VIP databases were searched to collect randomized controlled trials about bivalirudin and heparin in patients undergoing PCI from inception to July 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. RevMan 5.0 software was used for Meta analysis. Results:A total 18 studies were included, involving 52 203 patients. Meta analysis showed bivalirudin would not increase the MACE in 30 days, compared with heparin [RR=1.07, 95%CI (1.00, 1.14), P=0.05]; but major bleeding in 30 days significantly decreased in bivalirudin compared with heparin [RR=0.69, 95%CI (0.57, 0.84) ,P<0.001]. Stent thrombosis in 30 days was higher in bivalirudin than heparin [RR=1.40, 95%CI (1.10, 1.77), P=0.006], sub group analysis indicated continuing bivalirudin infusion after PCI would not increase stent thrombosis [RR=1.17, 95%CI (0.55, 2.52), P=0.68], while discontinuing bivalirudin infusion after PCI would increase stent thrombosis significantly [RR=1.74, 95%CI (1.23, 2.47) , P=0.002]. Conclusion:Bivalirudin was not inferior to heparin in efficacy for patients undergoing PCI; but bivalirudin had an advantage in safety as it reduced major bleeding in 30 days, which at the expense of increasing stent thrombosis in 30 days, while continuing bivalirudin infusion after PCI dose not increase risk of stent thrombosis. |
