Evidence map›Paper›PMID 26377400›Full record

ArticleEuropean heart journal2016

The comparative efficacy of bivalirudin is markedly attenuated by use of radial access: insights from Blue Cross Blue Shield of Michigan Cardiovascular Consortium.

Emily Perdoncin, Milan Seth, Simon Dixon, Louis Cannon, Akshay Khandelwal, Arthur Riba, Shukri David, David Wohns, Hitinder Gurm

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
4.0field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 1 country.

Emily PerdoncinDivision of Cardiovascular Medicine, University of Michigan Health System, 2A394, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
Milan SethDivision of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Simon DixonDivision of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA.
Louis CannonCardiac and Vascular Research Center of Northern Michigan, Petoskey, MI, USA.
Akshay KhandelwalOutpatient Cardiovascular Services, Henry Ford Hospital, Detroit, MI, USA.
Arthur RibaDivision of Cardiovascular Medicine, Oakwood Hospital, Dearborn, MI, USA.
Shukri DavidDivision of Cardiovascular Medicine, St. John Providence Hospital, Detroit, MI, USA.
David WohnsDivision of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI, USA.
Hitinder GurmDivision of Cardiovascular Medicine, University of Michigan Health System and Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA hgurm@med.umich.edu.
Michigan Medicine · USBeaumont Health · USBeaumont Hospital, Dearborn · USCardiac And Vascular Research Center Of Northern Michigan · USHenry Ford Hospital · USProvidence Hospital · USSpectrum Health · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThe purpose of our study was to evaluate the relative impact of bivalirudin on bleeding outcomes associated with trans-radial interventions (TRI) in real world practice. METHODS AND

resultsData for patients undergoing percutaneous coronary intervention (PCI) between January 2010 and March 2014 at the 47 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) were utilized. Propensity matching was used within cohorts defined by access site. The impact of bivalirudin use on in-hospital outcomes was evaluated with Fisher's exact tests. Among patients undergoing trans-femoral interventions (TFI), use of bivalirudin was associated with a reduction in bleeding compared with both glycoprotein IIb/IIIa inhibitors (GPI; 1.67 vs. 3.46%, absolute risk reduction (ARR) 1.79%, odds ratio, OR, 0.47, confidence interval, CI, 0.41-0.54, number needed to treat, NNT 56, P < 0.001) and heparin (1.26 vs. 1.76%, ARR 0.5%, OR 0.71, CI 0.61-0.82, NNT 197, P < 0.001). Among patients undergoing TRI, there was a more modest absolute reduction in bleeding with bivalirudin compared with GPI (0.79 vs. 1.41%, ARR 0.62%, OR 0.56, CI 0.34-0.90, NNT 161, P = 0.016) and no difference in bleeding compared with heparin (0.46 vs. 0.46%, OR 1, CI 0.54-1.84, P = 1).

conclusionBivalirudin is markedly efficacious in reducing bleeding in patients undergoing TFI. The reduction in bleeding associated with bivalirudin use is minimal to absent in patients undergoing TRI. Given its lower cost and comparable outcomes, heparin should be the preferred anticoagulation strategy in those undergoing radial PCI.

Indexed as

AnticoagulantsBlue Cross Blue Shield Insurance PlansHeparinHirudinsHumansMichiganPeptide FragmentsPercutaneous Coronary InterventionPlatelet Glycoprotein GPIIb-IIIa ComplexRecombinant ProteinsTreatment OutcomeAnticoagulantsbivalirudinHeparinHirudinsPeptide FragmentsPlatelet Glycoprotein GPIIb-IIIa ComplexRecombinant ProteinsBivalirudinBleedingRadial access

Identifiers

PMID26377400
PMCPMC4917745
OpenAlexW2063367113

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.