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Peer-reviewedCC BY-NC-SA 4.0Annals of Cardiac Anaesthesia

Bivalirudin Versus Heparin and Protamine in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

  • Matthew Cadd1
  • Samira Green1
  • Daniel Puntis1
  • Hans van Huellen1
  • Miles Seavill2
  • Sam Bullard3
  1. 1Department of Anaesthesia, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Sussex, United Kingdom
  2. 2Department of Anaesthesia, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
  3. 3Department of Anaesthesia, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Abstract

Objectives:: To summarize the evidence on the morbidity, mortality, and transfusion requirements of adult patients undergoing cardiac surgery using bivalirudin for anticoagulation compared to unfractionated heparin (UFH).

Measurements and Main Results:: A total of 407 patients in three randomized controlled trial (RCTs) were included for pooled analysis. There was no significant difference in the primary outcome; reexploration for hemorrhage between groups (risk ratio: 1.38, 95% confidence interval: 0.42 to 4.48). There were no observable differences in any of the secondary outcomes; thromboembolic events (myocardial infarction, stroke, pulmonary embolism), mortality, or postoperative transfusion requirements (packed red cells (PRC), platelets, cryoprecipitate, fresh frozen plasma (FFP)). All studies included were assessed to have some concern for risk of bias. Interstudy heterogeneity was low across all comparisons.

Conclusion:: Bivalirudin has not been shown to have any significant difference to UFH on clinical outcomes in patients undergoing cardiac surgery, and as per current international guidelines, can be considered for safe use in those patients for whom UFH is contraindicated. The study is limited by the bias of the included studies and the variability of bivalirudin drug dosage and its therapeutic monitoring; further, well-powered RCTs are required.

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Cite

BibTeXRIS
BibTeX
@article{cadd2026bivalirudin,
  title = {{Bivalirudin Versus Heparin and Protamine in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis}},
  author = {Matthew Cadd and Samira Green and Daniel Puntis and Hans van Huellen and Miles Seavill and Sam Bullard},
  journal = {Annals of Cardiac Anaesthesia},
  year = {2026},
  month = oct,
  doi = {10.4103/aca.aca_28_26},
  url = {https://doi.org/10.4103/aca.aca_28_26},
  note = {CC BY-NC-SA 4.0},
}
RIS
TY  - JOUR
TI  - Bivalirudin Versus Heparin and Protamine in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis
AU  - Matthew Cadd
AU  - Samira Green
AU  - Daniel Puntis
AU  - Hans van Huellen
AU  - Miles Seavill
AU  - Sam Bullard
PY  - 2026
DA  - 2026/10/12
JO  - Annals of Cardiac Anaesthesia
DO  - 10.4103/aca.aca_28_26
UR  - https://doi.org/10.4103/aca.aca_28_26
AB  - Objectives:: To summarize the evidence on the morbidity, mortality, and transfusion requirements of adult patients undergoing cardiac surgery using bivalirudin for anticoagulation compared to unfractionated heparin (UFH).  Measurements and Main Results:: A total of 407 patients in three randomized controlled trial (RCTs) were included for pooled analysis. There was no significant difference in the primary outcome; reexploration for hemorrhage between groups (risk ratio: 1.38, 95% confidence interval: 0.42 to 4.48). There were no observable differences in any of the secondary outcomes; thromboembolic events (myocardial infarction, stroke, pulmonary embolism), mortality, or postoperative transfusion requirements (packed red cells (PRC), platelets, cryoprecipitate, fresh frozen plasma (FFP)). All studies included were assessed to have some concern for risk of bias. Interstudy heterogeneity was low across all comparisons.  Conclusion:: Bivalirudin has not been shown to have any significant difference to UFH on clinical outcomes in patients undergoing cardiac surgery, and as per current international guidelines, can be considered for safe use in those patients for whom UFH is contraindicated. The study is limited by the bias of the included studies and the variability of bivalirudin drug dosage and its therapeutic monitoring; further, well-powered RCTs are required.
SN  - 0971-9784
SN  - 0974-5181
ER  -