Author + information
- S1936879815021032-5b7636d8d04484081f5f4924f987cae2Michael J. Lipinski,
- S1936879815021032-54a0fbea81b3f9de43b8452c779f1b2bRegina C. Lee,
- S1936879815021032-bbfe4b1a6caf8afb1be83f37a64f1642Michael A. Gaglia Jr.,
- S1936879815021032-bf29c8f13fbb53b703a3aa00bd1aca7cHector M. Garcia-Garcia,
- S1936879815021032-43188b297454714a1e633ce32956ff39Rebecca Torguson,
- S1936879815021032-6a643b5155cb73800c3dcdf29c00727cAugusto D. Pichard,
- S1936879815021032-1afcf597a9ea0e6a884d08efd238ef1fLowell F. Satler and
- S1936879815021032-772b1cb1fca98a9f26e1e7f8bddc725bRon Waksman
Numerous randomized controlled trials (RCTs) have been conducted comparing different anticoagulation strategies for percutaneous coronary intervention (PCI) but comparison between different glycoprotein IIb/IIIa inhibitors (GPI) is limited. Thus, we performed a Bayesian network meta-analysis to directly and indirectly compare different GPI strategies for PCI with a focus on the impact of high-dose bolus (HDB) tirofiban.
We searched MEDLINE and CENTRAL for RCTs studies comparing HDB tirofiban, abciximab, eptifibatide, heparin with provisional GPI, and bivalirudin with provisional GPI that reported clinical outcomes with a preference for use of 30-day events. All included studies utilized dual anti-platelet therapy. Mixed treatment comparison model generation was performed to directly and indirectly compare between different anticoagulation strategies.
A total of 41 RCTs with 38,645 patients were included in the analysis, among which 2,654 were randomized to HDB tirofiban, 6,752 to abciximab, 1,669 to eptifibatide, 16,500 to heparin, and 11,070 to bivalirudin. Mean age was 64±11 years, 75% were male, 91% were treated with stenting, 71% with clopidogrel, 46% presented with STEMI, and 74% for ACS. As seen in Figure 1, tirofiban was associated with a significant reduction in all-cause mortality compared with eptifibatide or heparin. There was no difference among the GPI therapies for other outcomes including MI, MACE, and major bleeding. However, abciximab was associated with greater risk of thrombocytopenia (p<0.01). Bivalirudin was associated with less major and minor bleeding compared with a GPI anticoagulation strategy.
Our network meta-analysis of 38,645 patients demonstrated that HDB tirofiban was associated with comparable or superior performance to other GPI for PCI.