Direct thrombin inhibitors in acute coronary syndromes: principal results of a meta-analysis based on individual patients' data.
Background: To obtain more reliable and precise estimates of the effect of direct thrombin inhibitors in the management of acute coronary syndromes, including patients undergoing percutaneous coronary intervention, we undertook a meta-analysis based on individual patients' data from randomised trial...
| Publicado en: | Lancet Vol. 359; no. 9303; pp. 294 - 303 |
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| Formato: | research Journal Article |
| Publicado: |
Lancet
1/26/2002
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119726409&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 119726409 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 1/26/2002 vid: 359 iid: 9303 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 119726409 119726409 NLM11830196 119726409 10.1016/s0140-6736(02)07495-0 NLM11830196 119726409 ppf: 294 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Direct thrombin inhibitors in acute coronary syndromes: principal results of a meta-analysis based on individual patients' data. aug: sug: subj: Thrombin Antagonists and Inhibitors Glycine Analogs and Derivatives Myocardial Infarction Drug Therapy Proteins Therapeutic Use Hirudin Angina, Unstable Drug Therapy Oligopeptides Therapeutic Use Recombinant Proteins Therapeutic Use Angina, Unstable Mortality Piperidines Therapeutic Use Human Myocardial Infarction Mortality Glycine Therapeutic Use Thrombolytic Therapy Heparin Therapeutic Use Survival Clinical Trials Peptides Therapeutic Use Meta Analysis Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales ab: Background: To obtain more reliable and precise estimates of the effect of direct thrombin inhibitors in the management of acute coronary syndromes, including patients undergoing percutaneous coronary intervention, we undertook a meta-analysis based on individual patients' data from randomised trials comparing a direct thrombin inhibitor (hirudin, bivalirudin, argatroban, efegatran, or inogatran) with heparin.Methods: We included trials that involved at least 200 patients. The primary efficacy outcome was death or myocardial infarction, and the primary safety outcome was major bleeding. Data from individual trials were combined by use of a modified Mantel-Haenszel method.Findings: In 11 randomised trials, 35,970 patients were assigned up to 7 days' treatment with a direct thrombin inhibitor or heparin and followed up for at least 30 days. Compared with heparin, direct thrombin inhibitors were associated with a lower risk of death or myocardial infarction at the end of treatment (4.3% vs 5.1%; odds ratio 0.85 [95% CI 0.77-0.94]; p=0.001) and at 30 days (7.4% vs 8.2%; 0.91 [0.84-0.99]; p=0.02). This was due primarily to a reduction in myocardial infarctions (2.8% vs 3.5%; 0.80 [0.71-0.90]; p<0.001) with no apparent effect on deaths (1.9% vs 2.0%; 0.97 [0.83-1.13]; p=0.69). Subgroup analyses suggested a benefit of direct thrombin inhibitors on death or myocardial infarction in trials of both acute coronary syndromes and percutaneous coronary interventions. A reduction in death or myocardial infarction was seen with hirudin and bivalirudin but not with univalent agents. Compared with heparin, there was an increased risk of major bleeding with hirudin, but a reduction with bivalirudin. There was no excess in intracranial haemorrhage with direct thrombin inhibitors.Interpretation: Direct thrombin inhibitors are superior to heparin for the prevention of death or myocardial infarction in patients with acute coronary syndromes. This information should prompt further clinical development of direct thrombin inhibitors for the management of arterial thrombosis. pubtype: Academic Journal doctype: meta analysis research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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