The efficacy and safety of bivalirudin and heparin in patients with acute coronary syndrome: a systematic review and meta-analysis

Zhai, You; Shang, Hongcai; Li, Yan; Zhang, Nan; Zhang, Jisi; Wu, Shangwen

doi:10.1186/s13643-025-02782-7

Systematic Reviews

Table 1 The characteristics of all the included studies

From: The efficacy and safety of bivalirudin and heparin in patients with acute coronary syndrome: a systematic review and meta-analysis

First author	Years	Number of cases (B/H)	Age (B/H)	Men ratio (B/H)	Intervention		Dose		Outcome
First author	Years	Number of cases (B/H)	Age (B/H)	Men ratio (B/H)	Bivalirudin	Heparin	Bivalirudin	Heparin	Outcome
Omerovic [18]	2024	3004/3002	72.6/73.3	70.1/72.9	Single use B/B + GPIIb/IIIa antagonist	H or enoxaparin + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus	①⑤⑥
Song [19]	2023	30/30	73.5/73.6	53/57	B + aspirin + clopidogrel bisulfate tablets	H + aspirin + clopidogrel bisulfate tablets	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	100 IU/kg	③⑤
Li Y. [20]	2022	3009/3007	71/73	67/71	Single use	H + temporarily given GPIIb /IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻⁻¹·h⁻¹ upkeep	60 IU/kg bolus	⑤
James [21]	2021	1501/1504	68/70	70.1/73.6	Single use	Single use	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus injection, 12 IU·kg⁻¹·h⁻¹ dimension hold	①⑦
Wester [22]	2020	799/793	73/71	71/70	Single use	H or enoxaparin + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	100 IU/kg	①④⑤
Li Y. Z. [23]	2020	34/34	57.5/58.2	62/53	B + clopidogrel + aspirin	H + clopidogrel + aspirin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	100 IU/kg	③⑤
Erlinge [24]	2019	1503/1498	68/70	64/68	B + GPIIb/IIIa antagonist	H or enoxaparin + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	100 IU/kg bolus	①⑤
Li C. [25]	2018	42/42	71.2/72.9	74/76	B + GPIIb/IIIa antagonist	H + heparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus	③⑤
Czarny [26]	2017	3380/4553	69/71	68.8/69.3	Single use	Single use	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus injection, 12 IU·kg⁻¹·h⁻¹ dimension hold	①④⑦
Lima [27]	2018	123/137	70.3/69.5	65.3/66.8	Single use	Single use	1. 0 mg/kg static push, then 2.5 mg·kg⁻¹·h⁻¹ for 4 h, and finally 0.2 mg·kg⁻¹·h⁻¹ for 14–20 h	60 IU/kg bolus	③⑤
Wang [28]	2017	576/576	66/68	70/68	B + clopidogrel + aspirin	H + temporarily given GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus injection, 12 IU·kg⁻¹·h⁻¹ dimension hold	③⑤
Erlinge [29]	2016	3004/3006	69/70	65/68	B + GPIIb/IIIa antagonist	H or enoxaparin + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus injection, 12 IU·kg⁻¹·h⁻¹ dimension hold	①④⑤
Briguori [30]	2015	3610/3603	67.5/69.1	71.6/72.8	B + clopidogrel + aspirin	H + temporarily given GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus	①⑤⑦
Han [31]	2015	655/629	57.3/58.2	82.7/81.9	Single use	Single use	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ for 4 h	100 IU/kg bolus injection, dose adjusted to ACT < 200 s	①②③④⑤⑥
Feldman [32]	2014	50/50	-	78/60	Single use	Single use	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	-	①⑤
Schulz [33]	2014	269 / 275	61.4/61.4	76/79	B + prasugrel	H + heparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	70 ~ 100 IU/kg bolus injection, adjust the dose to make ACT 200 ~ 250 s	①②③④⑤⑥
Shahzad [34]	2014	905 / 907	62.9/63.6	64.7/66.3	Single use	Heparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	70 IU/kg bolus	①②③④⑤⑥
Steg [35]	2013	1089/1109	61/62	73.7/77.6	Single use	H ± GPI or enoxaparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	100 IU/kg or 60 IU/kg + GPIIb/IIIa or enoxaparin (0.5 mg/kg)	①②③④⑤⑥
Waksman [36]	2013	51/49	63.3/62.2	72.5/63.3	Single use	H + temporarily given GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ upkeep	60 IU/kg bolus injection, adjust the dose to make ACT < 200 s	①⑤
Xiang [37]	2013	105/102	63/65	84/82	Single use	H + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	60 IU/kg bolus	①⑤
Patti [38]	2012	198/203	70 /70	71/73	Single use	Single use	1. 0 mg/kg static push, then 2.5 mg·kg⁻¹·h⁻¹ for 4 h, and finally 0.2 mg·kg⁻¹·h⁻¹ for 14–20 h	100 IU/kg bolus	①③④⑤
Kastrati [39]	2011	2289/2281	67.5/67.5	76.9/76.8	Single use	H + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	70 IU/kg bolus	①③④⑤⑦
Moliterno [40]	2011	185/198	-	-	B + GPIIb/IIIa antagonist	H + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	50 IU/kg	①⑤
Parodi [41]	2010	363/308	69/69	77/75	Single use	H + heparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	70 IU/kg bolus injection, adjust dose to ACT 200 ~ 250 s	①④⑤⑦
Mehran [42]	2009	1800/1802	59.8/60.7	59.8/60.7	Single use	H + GPI	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	60 IU/kg bolus injection, adjust the dose to make ACT 200 ~ 250 s	①②③④⑤⑥
Stone [43]	2007	5228/2561	63/62	74/73	Single use B/B + GPIIb/IIIa antagonist	H or enoxaparin + GPIIb/IIIa antagonist	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	60 IU/kg bolus injection, 12 IU·kg⁻¹·h⁻⁻¹ dimension hold	①⑤
Gurm [44]	2005	864/801	66/66	70/73	Single use	H + heparin	0.75 mg/kg bolus injection + 1.75 mg·kg⁻¹·h⁻¹ maintenance	70 ~ 100 IU/kg bolus injection, adjust the dose to make ACT 200 ~ 250 s	①③④⑦

B Bivalirudin, H Heparin ①, all-cause mortality; ②, incidence of thrombosis; ③, incidence of major adverse events; ④, rate of recurrent myocardial infarction; ⑤, incidence of short-term bleeding events; ⑥, incidence of revascularization; ⑦, incidence of retransfusion

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ISSN: 2046-4053

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