Evidence-Based Medicine Online First, published on March 3, 2015 as 10.1136/ebmed-2014-110150
Therapeutics
Systematic review with meta analysis
Meta-analysis compares anticoagulant strategies in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention 10.1136/ebmed-2014-110150
Giuseppe Patti Campus Bio-Medico University—Cardiovascular Sciences, Rome, Italy Correspondence to: Dr Giuseppe Patti, Campus Bio-Medico University— Cardiovascular Sciences, Via Alvaro del Portillo, 200, Rome 00128, Italy; [email protected]
Commentary on: Bangalore S, Toklu B, Kotwal A, et al. Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomised trials in the era of stents and P2Y12 inhibitors. BMJ 2014;349:g6419
Context Optimal anticoagulant therapy in patients receiving primary intervention for acute myocardial infarction (MI) is widely debated. Prior studies have been heterogeneous in doses and concomitant treatments such that it has been unclear whether effects have been those of newer medication or a result of changes in these co-interventions. A meta-analytic approach can allow comparisons between multiple anticoagulant strategies and can help clarify heterogeneity and address power in pooled analyses.
Methods The authors performed a study-level meta-analysis on 22 randomised controlled trials including patients with ST-elevation MI who were undergoing stent placement and were administered P2Y12 inhibitors (N=22 434 patients). The treatment strategies considered included: unfractionated heparin (UFH) alone, UFH plus IIb-IIIa inhibitors, fondaparinux, bivalirudin and low-molecular weight heparin (LMWH) plus IIb-IIIa inhibitors. Main efficacy outcome was incidence of major adverse cardiovascular events (death, MI, urgent target vessel or lesion revascularisation or stroke) during hospital stay or
Therapeutics
Systematic review with meta analysis
Meta-analysis compares anticoagulant strategies in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention 10.1136/ebmed-2014-110150
Giuseppe Patti Campus Bio-Medico University—Cardiovascular Sciences, Rome, Italy Correspondence to: Dr Giuseppe Patti, Campus Bio-Medico University— Cardiovascular Sciences, Via Alvaro del Portillo, 200, Rome 00128, Italy; [email protected]
Commentary on: Bangalore S, Toklu B, Kotwal A, et al. Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomised trials in the era of stents and P2Y12 inhibitors. BMJ 2014;349:g6419
Context Optimal anticoagulant therapy in patients receiving primary intervention for acute myocardial infarction (MI) is widely debated. Prior studies have been heterogeneous in doses and concomitant treatments such that it has been unclear whether effects have been those of newer medication or a result of changes in these co-interventions. A meta-analytic approach can allow comparisons between multiple anticoagulant strategies and can help clarify heterogeneity and address power in pooled analyses.
Methods The authors performed a study-level meta-analysis on 22 randomised controlled trials including patients with ST-elevation MI who were undergoing stent placement and were administered P2Y12 inhibitors (N=22 434 patients). The treatment strategies considered included: unfractionated heparin (UFH) alone, UFH plus IIb-IIIa inhibitors, fondaparinux, bivalirudin and low-molecular weight heparin (LMWH) plus IIb-IIIa inhibitors. Main efficacy outcome was incidence of major adverse cardiovascular events (death, MI, urgent target vessel or lesion revascularisation or stroke) during hospital stay or
