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Condition

Percutaneous Coronary Intervention

Percutaneous coronary intervention is a procedure that uses a catheter and usually a stent to open a narrowed heart artery and restore blood flow. The evidence is strongest for bivalirudin, which brought less major bleeding than heparin plus another clot-blocking drug, and eptifibatide, after which fewer people had a death or heart attack following stenting. Eptifibatide's findings came from one trial of about 2,000 people followed for six months.

Sources: PMID 21700252; PMID 20598998

Supplements studied
0
Medicines and peptides
2
Graded outcomes
5
No supplement studies yetWe haven’t found supplement studies for Percutaneous Coronary Intervention. The medicines and peptides studied for it are listed below.

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use.

2 medicines and peptides

Bivalirudin

Bivalirudin: outcomes studied for Percutaneous Coronary Intervention
GradeOutcomeEffectSizeStudiesPeopleStudies list
Net Adverse Clinical Events

HORIZONS-AMI: NACE 9.2% vs 12.1% with heparin+GPI at 30 days. ACUITY: Similar ischemic outcomes with reduced bleeding. 1-year follow-up confirmed sustained benefit. Net clinical benefit driven primarily by bleeding reduction.

Improves (the measure goes down)Moderate effect79 studies

Studies that measured net adverse clinical events

and 76 more on the Bivalirudin page

Major Bleeding Reduction

HORIZONS-AMI: Major bleeding 4.9% vs 8.3% with heparin+GPI (P<0.001). ACUITY: 47% relative reduction in major bleeding. REPLACE-2: Significantly lower bleeding with bivalirudin monotherapy. Consistent across 25,000+ patients in pooled analyses.

Improves (the measure goes down)Large effect75 studies

Studies that measured major bleeding reduction

and 72 more on the Bivalirudin page

Acute Stent Thrombosis

SAFETY CONCERN: HORIZONS-AMI: Higher acute stent thrombosis within 24h (1.3% vs 0.3%, P<0.001). HEAT-PPCI: Stent thrombosis 3.4% vs 0.9% with heparin. Mitigated by post-PCI bivalirudin infusion (BRIGHT trial). ESC guidelines downgraded to Class IIb in 2018.

Worsens (the measure goes down)Small effect79 studies

Studies that measured acute stent thrombosis

and 76 more on the Bivalirudin page

Mortality

HORIZONS-AMI: 1-year all-cause mortality 3.5% vs 4.8% (P=0.037). Cardiac mortality 2.1% vs 3.1% (P=0.047). VALIDATE-SWEDEHEART: No mortality difference vs heparin alone at 180 days. Mortality benefit may relate to bleeding reduction.

Improves (the measure goes down)Moderate effect76 studies

Studies that measured mortality

and 73 more on the Bivalirudin page

Eptifibatide (Integrilin)

Eptifibatide (Integrilin): outcomes studied for Percutaneous Coronary Intervention
GradeOutcomeEffectSizeStudiesPeopleStudies list
Death/MI After PCI Stenting

ESPRIT (n=2,064): Death/MI/TVR 7.5% vs 11.5% at 6 months (HR 0.63, P=0.002). MI reduced at 48h from 9% to 5.4% (P=0.0015). 37% relative risk reduction. Double-bolus regimen.

Improves (the measure goes down)Moderate effect21 studies

Studies that measured death/mi after pci stenting

and 18 more on the Eptifibatide (Integrilin) page

Key findings

  • Net Adverse Clinical EventsBivalirudinImproves (the measure goes down)
  • Major Bleeding ReductionBivalirudinImproves (the measure goes down)
  • Death/MI After PCI StentingEptifibatide (Integrilin)Improves (the measure goes down)

Safety notes in the studies

  • 37% relative risk reduction.

Studies cited

100 studies from PubMed

  1. Eptifibatide as an adjuvant therapy to thrombolysis versus thrombolysis alone in stroke management: a systematic review and meta-analysis of randomized controlled trials.Journal of thrombosis and thrombolysis, 2025 · PMID 40544389
  2. Intraoperative Bivalirudin Use in Patient Undergoing Femoral Endarterectomy with Heparin-Induced Thrombocytopenia: Case Report and Review of the Literature.Vascular and endovascular surgery, 2024 · PMID 38016142
  3. Bivalirudin versus heparin in contemporary percutaneous coronary interventions for patients with acute coronary syndrome: a systematic review and meta-analysis.Cardiology journal, 2024 · PMID 37964648
  4. Meta-Analysis Comparing Bivalirudin Versus. Unfractionated Heparin in Adult Patients With Extracorporeal Membrane Oxygenation.Journal of pharmacy practice, 2024 · PMID 36449392
  5. A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction.Cardiovascular revascularization medicine : including molecular interventions, 2023 · PMID 36737382
  6. Heparin Versus Bivalirudin for Anticoagulation in Adult Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.ASAIO journal (American Society for Artificial Internal Organs : 1992), 2023 · PMID 36355803
  7. Bivalirudin versus heparin in adult and pediatric patients with extracorporeal membrane oxygenation therapy: A systematic review and meta-analysis.Pharmacological research, 2022 · PMID 35065202
  8. Is bivalirudin an alternative anticoagulant for extracorporeal membrane oxygenation (ECMO) patients? A systematic review and meta-analysis.Thrombosis research, 2022 · PMID 35007937
  9. Practicability of Bivalirudin plus Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2021 · PMID 34775846
  10. A Review of Bivalirudin for Pediatric and Adult Mechanical Circulatory Support.American journal of cardiovascular drugs : drugs, devices, and other interventions, 2021 · PMID 33174088
  11. Clinical Outcomes of Bivalirudin Versus Heparin in Elderly Patients Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Controlled Trials.Cardiovascular drugs and therapy, 2020 · PMID 32100149
  12. Meta-analysis of bivalirudin versus heparin in transradial coronary interventions.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2020 · PMID 32091668
  13. Bivalirudin Versus Heparin During Intervention in Acute Coronary Syndrome: A Systematic Review of Randomized Trials.Cardiovascular & hematological disorders drug targets, 2020 · PMID 31241442
  14. Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial.Journal of the American Heart Association, 2019 · PMID 31766977
  15. Bivalirudin versus heparin in patients undergoing percutaneous transcatheter aortic valve interventions: A systematic review and meta-analysis.Journal of interventional cardiology, 2017 · PMID 28833456
  16. Gender-based outcomes of bivalirudin versus heparin in patients undergoing percutaneous coronary interventions: Meta-analysis of randomized controlled trials.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2017 · PMID 28339139
  17. Bivalirudin versus heparin in women undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomized clinical trials.Cardiovascular revascularization medicine : including molecular interventions, 2017 · PMID 28291727
  18. Bivalirudin versus Heparin plus Glycoprotein IIb/IIIa Inhibitors in Women Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.PloS one, 2017 · PMID 28095453
  19. Bivalirudin versus Heparin Monotherapy in Myocardial InfarctionN Engl J Med, 2017 · PMID 28844201
  20. Bivalirudin Versus Unfractionated Heparin in Acute Coronary Syndromes: An Updated Meta-analysis of Randomized Trials.Revista espanola de cardiologia (English ed.), 2016 · PMID 27198128
  21. Bivalirudin versus unfractionated heparin for percutaneous coronary intervention with radial access: A meta-analysis of randomized trials.International journal of cardiology, 2016 · PMID 27153137
  22. Prediction of 1-year mortality and impact of bivalirudin therapy according to level of baseline risk: A patient-level pooled analysis from three randomized trialsAm Heart J, 2016 · PMID 26624854
  23. Bivalirudin Anticoagulant Therapy With or Without Platelet Glycoprotein IIb/IIIa Inhibitors During Transcatheter Coronary Interventional Procedures: A Meta-Analysis.Medicine, 2015 · PMID 26266343
  24. Bivalirudin versus heparin in patients treated with percutaneous coronary intervention: a meta-analysis of randomised trials.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2015 · PMID 25102830
  25. Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trialJAMA, 2015 · PMID 25775052
  26. Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature.Neuroradiology, 2014 · PMID 24281387
  27. Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials.Cardiovascular revascularization medicine : including molecular interventions, 2014 · PMID 25440505
  28. Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials.Lancet (London, England), 2014 · PMID 25131979
  29. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trialLancet, 2014 · PMID 25002178
  30. The kinetics of integrilin limited by obesity: a multicenter randomized pharmacokinetic and pharmacodynamic clinical trial.American heart journal, 2011 · PMID 22137072
  31. Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2, ACUITY, and HORIZONS-AMI trialsJACC Cardiovasc Interv, 2011 · PMID 21700252
  32. Comparison by meta-analysis of eptifibatide and tirofiban to abciximab in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.The American journal of cardiology, 2010 · PMID 20598998
  33. Prolonged infusion of eptifibatide as bridge therapy between bare-metal stent insertion and cardiovascular surgery: case report and review of the literature.Pharmacotherapy, 2010 · PMID 20334463
  34. Bivalirudin: a review of the pharmacology and clinical application.Expert review of cardiovascular therapy, 2010 · PMID 21108549
  35. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomised controlled trialLancet, 2009 · PMID 19717185
  36. EptifibatideExpert Opin Pharmacother, 2008 · PMID 31082110
  37. BivalirudinThromb Haemost, 2008 · PMID 18449412
  38. Safety and efficacy of bivalirudin with and without glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention 1-year results from the ACUITY trialCirculation, 2008 · PMID 18755342
  39. A review of clinical trials with eptifibatide in cardiology.Cardiovascular drug reviews, 2007 · PMID 18078431
  40. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trialLancet, 2007 · PMID 17368152
  41. Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial.American heart journal, 2006 · PMID 16996831
  42. Eptifibatide: a review of its use in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention.Drugs, 2005 · PMID 16162023
  43. Eptifibatide: a pharmacoeconomic review of its use in percutaneous coronary intervention and acute coronary syndromes.PharmacoEconomics, 2003 · PMID 12908844
  44. Eptifibatide in percutaneous coronary intervention. A review.Minerva cardioangiologica, 2002 · PMID 12384635
  45. Bivalirudin: a review of its potential place in the management of acute coronary syndromes.Drugs, 2002 · PMID 11929334
  46. Bivalirudin: a review of its use in patients undergoing percutaneous coronary interventionDrugs, 2002 · PMID 16114983
  47. Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial: a randomized controlled trialJAMA, 2001 · PMID 11368699
  48. Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. PURSUIT InvestigatorsCirculation, 2000 · PMID 10683348
  49. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trialLancet, 2000 · PMID 11145489
  50. Eptifibatide: a review of its use in patients with acute coronary syndromes and/or undergoing percutaneous coronary interventionDrugs, 1999 · PMID 10193692
  51. Modifiable risk factors for vascular access site complications in the IMPACT II Trial of angioplasty with versus without eptifibatideJ Am Coll Cardiol, 1998 · PMID 9626829
  52. Impact of eptifibatide on early ischemic events in acute ischemic coronary syndromes: a review of the IMPACT II trial. Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis.The American journal of cardiology, 1997 · PMID 9291242
  53. Design and methodology of the PURSUIT trial: evaluating eptifibatide for acute ischemic coronary syndromesAm Heart J, 1997 · PMID 9291244
  54. Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-IILancet, 1997 · PMID 9164315
  55. The effects of circuit-based resistance training on blood pressure, arterial stiffness, and body composition in community-dwelling older adults: a systematic review and meta-analysis.Front Physiol · PMID 40464000
  56. Yerba Mate (Ilex paraguariensis) consumption is associated with higher bone mineral density in postmenopausal womenBone · PMID 21920487
  57. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysisNutr Rev · PMID 30376075
  58. The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal womenJ Bone Miner Res · PMID 21590739
  59. Effect of Vitamin K on Bone Mineral Density and Fracture Risk in Adults: Systematic Review and Meta-Analysis.Biomedicines · PMID 35625785
  60. Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials.Osteoporos Int · PMID 31076817
  61. Randomized pilot trial of vitamin K2 for bone loss in patients with primary biliary cirrhosisJ Hepatol · PMID 11682046
  62. Effect of continuous combined therapy with vitamin K(2) and vitamin D(3) on bone mineral density and coagulofibrinolysis function in postmenopausal womenMaturitas · PMID 11886767
  63. Vitamin K, circulating cytokines, and bone mineral density in older men and womenAm J Clin Nutr · PMID 18689371
  64. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal womenOsteoporos Int · PMID 23525894
  65. Effect of vitamin K supplementation on bone loss in elderly men and womenJ Clin Endocrinol Metab · PMID 18252784
  66. Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American womenJ Bone Miner Res · PMID 19113922
  67. Low-dose vitamin K2 (MK-4) supplementation for 12 months improves bone metabolism and prevents forearm bone loss in postmenopausal Japanese womenJ Bone Miner Metab · PMID 23702931
  68. Vitamin K2 supplementation improves hip bone geometry and bone strength indices in postmenopausal womenOsteoporos Int · PMID 17287908
  69. Factors affecting bone loss in female endurance athletes: a two-year follow-up studyAm J Sports Med · PMID 14623654
  70. A longitudinal study of the effect of vitamin K2 on bone mineral density in postmenopausal women a comparative study with vitamin D3 and estrogen-progestin therapyMaturitas · PMID 10227010
  71. Effect of vitamin K on bone mineral density: a meta-analysis of randomized controlled trialsJ Bone Miner Metab · PMID 21674202
  72. Changes in bone turnover after high-dose vitamin D supplementation during acute pulmonary exacerbation in cystic fibrosis.Bone · PMID 37390941
  73. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trialsArch Intern Med · PMID 19307517
  74. Supplementation with 1000 IU vitamin D/d leads to parathyroid hormone suppression, but not increased fractional calcium absorption, in 4-8-y-old children: a double-blind randomized controlled trialAm J Clin Nutr · PMID 23151536
  75. Effect of antioxidants combined to resistance training on BMD in elderly women: a pilot studyOsteoporos Int · PMID 19020919
  76. Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderlyJ Nutr Health Aging · PMID 20617290
  77. Animal Versus Plant Protein and Adult Bone Health: A Systematic Review and Meta-Analysis From the National Osteoporosis FoundationPLoS One · PMID 29474360
  78. Soy isoflavones prevent bone resorption and loss, a systematic review and meta-analysis of randomized controlled trialsCrit Rev Food Sci Nutr · PMID 31290343
  79. The effect of isoflavones extracted from red clover (Rimostil) on lipid and bone metabolismMenopause · PMID 11449083
  80. The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trialAm J Clin Nutr · PMID 14749241
  81. Effect of isoflavones on lipids and bone turnover markers in menopausal womenMaturitas · PMID 15207886
  82. Red clover isoflavones are safe and well tolerated in women with a family history of breast cancerMenopause Int · PMID 18380954
  83. Effects and safety of Pueraria mirifica on lipid profiles and biochemical markers of bone turnover rates in healthy postmenopausal womenMenopause · PMID 18202589
  84. Effects of probiotic supplements on bone mineral density and bone turnover markers in postmenopausal women: A systematic review.Clin Nutr ESPEN · PMID 40716641
  85. The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysisOsteoporos Int · PMID 25572045
  86. Effects of combined protein and exercise interventions on bone health in middle-aged and older adults - A systematic literature review and meta-analysis of randomized controlled trials.Osteoporos Int · PMID 39915336
  87. A randomized controlled study of effects of dietary magnesium oxide supplementation on bone mineral content in healthy girlsJ Clin Endocrinol Metab · PMID 17018656
  88. Short-term oral magnesium supplementation suppresses bone turnover in postmenopausal osteoporotic womenBiol Trace Elem Res · PMID 19488681
  89. The effect of magnesium supplementation on biochemical markers of bone metabolism or blood pressure in healthy young adult femalesEur J Clin Nutr · PMID 10334649
  90. Epimedium-derived phytoestrogen flavonoids exert beneficial effect on preventing bone loss in late postmenopausal women: a 24-month randomized, double-blind and placebo-controlled trialJ Bone Miner Res · PMID 17419678
  91. Evaluation of the effect of glucosamine administration on biomarkers for cartilage and bone metabolism in soccer playersInt J Mol Med · PMID 19724889
  92. A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA supplementation of bone mineral density in healthy adults.Gynecol Endocrinol · PMID 31237150
  93. Dehydroepiandrosterone replacement therapy in older adults: 1- and 2-y effects on boneAm J Clin Nutr · PMID 19321570
  94. Dehydroepiandrosterone supplementation and bone turnover in middle-aged to elderly menJ Clin Endocrinol Metab · PMID 11932279
  95. Effects of Curcumin on Postmenopausal Women's Health: A Systematic Review and Meta-Analysis.Phytother Res · PMID 40105038
  96. Creatine monohydrate and resistance training increase bone mineral content and density in older menJ Nutr Health Aging · PMID 16222402
  97. Effect of conjugated linoleic acid on body fat accretion in overweight or obese childrenAm J Clin Nutr · PMID 20200257
  98. Body composition and hormonal adaptations associated with forskolin consumption in overweight and obese menObes Res · PMID 16129715
  99. Clinical evaluation of cissus quadrangularis and moringa oleifera and osteoseal as osteogenic agents in mandibular fractureNatl J Maxillofac Surg · PMID 22639499
  100. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trialJ Clin Endocrinol Metab · PMID 11502782