比伐卢定与肝素单药治疗用于经皮冠状动脉介入术安全性的Meta分析

Safety of bivalirudin versus heparin monotherapy in percutaneous coronary intervention:a meta-analysis

目的系统评价比伐卢定与肝素单药治疗用于经皮冠状动脉介入术的安全性。方法计算机检索PubMed、EMbase、Cochrane Library、CBM、CNKI、维普和万方数据库(截止于2013年5月)获取相关临床对照试验。按照改良的Jadad量表评价纳入研究的质量,并采用RevMan5.2软件进行统计分析。结果共选取14项符合评价标准的研究,其中观察研究试验9项,随机对照试验5项,对照试验29 226例。分析结果表明,比伐卢定组病死率低于肝素组(OR=0.65,95%CI:0.43-0.99,P=0.04);大出血发生率亦低于肝素组(OR=0.65,95%CI:0.53-0.81,P=0.0001)。结论比伐卢定用于经皮冠状动脉介入术的安全性优于肝素,大出血发生率和病死率降低。

Objective To evaluate the safety of bivalirudin versus heparin monotherapy in percutaneous coronary intervention （PCI） systematically.Methods Relevant observational studies and randomized trials were retrieved from PubMed,EMbase,Cochrane Library,CBM,CNKI,VIP and WanFang database （all searches were ending in May 2013）.According to the modified Jadad scale evaluation,the quality of the included was evaluated; we used the RevMan5.2 software for a meta-analysis.Results This meta-analysis included 14 studies （including 9 observational studies and 5 randomized trials） which controlled 29 226 cases of trials.The results showed that,compared with the heparin monotherapy group,the bivalirudin group was associated with lower risk of mortality （OR =0.65,95％ CI：0.43-0.99,P =0.04） and also with lower risk of major bleeding （OR=0.65,95％ CI：0.53-0.81,P=0.0001）.Conclusion Bivalirudin in PCI is safer than heparin monotherapy,which relatively decreases the incidences of major bleeding and mortality.