Abstract
The direct thrombin inhibitor bivalirudin has gained popularity in cardiovascular medicine over the past decade because, in comparison with unfractionated heparin, it guarantees a predictable dose-related degree of anticoagulation with a low immunogenic profile and, possibly, with reduced rates of major bleeding complications.
In the past bivalirudin has been frequently employed in the management of patients with heparin-induced thrombocytopenia. The REPLACE-2, ACUITY and ISAR-REACT4 studies demonstrated bivalirudin non-inferiority in comparison with unfractionated heparin in terms of ischemic end-points with a reduction of the bleeding rate also in patients acute coronary syndrome without ST elevation. Finally the results of the HORIZONS-AMI study positioned this drug as a first choice anticoagulant during percutaneous coronary interventions in patients with ST-elevation myocardial infarction. In fact the bivalirudin alone regimen, compared to unfractionated heparin plus GP2b3a inhibitors, decreased inhospital bleeding rates and short and long term mortality. Given the body of clinical evidence, bivalirudin is likely to contend to GP2b3a inhibitors the leading place among the proposed anticoagulation strategies in the setting of acute coronary syndromes. The duration of the bivalirudin infusion after PCI and the optimal oral antiplatelet regimen associated to bivalirudin are important issues to be solved in future randomized controlled studies.
Keywords: Bivalirudin, STEMI, primary PCI, heparin, abciximab, GP2b3a inhibitors, bleeding, adjuvant therapy, coronary intervention, acute coronary syndrome.
Cardiovascular & Hematological Agents in Medicinal Chemistry
Title:Pharmacological Adjuvant Therapies in Primary Coronary Interventions: Bivalirudin
Volume: 11 Issue: 2
Author(s): Alessandro Lupi, Andrea Rognoni, Chiara Cavallino, Gioel G. Secco, Maria D. Prando, Matteo Santagostino, Maurizio Lazzero, Ettore Cassetti and Angelo S. Bongo
Affiliation:
Keywords: Bivalirudin, STEMI, primary PCI, heparin, abciximab, GP2b3a inhibitors, bleeding, adjuvant therapy, coronary intervention, acute coronary syndrome.
Abstract: The direct thrombin inhibitor bivalirudin has gained popularity in cardiovascular medicine over the past decade because, in comparison with unfractionated heparin, it guarantees a predictable dose-related degree of anticoagulation with a low immunogenic profile and, possibly, with reduced rates of major bleeding complications.
In the past bivalirudin has been frequently employed in the management of patients with heparin-induced thrombocytopenia. The REPLACE-2, ACUITY and ISAR-REACT4 studies demonstrated bivalirudin non-inferiority in comparison with unfractionated heparin in terms of ischemic end-points with a reduction of the bleeding rate also in patients acute coronary syndrome without ST elevation. Finally the results of the HORIZONS-AMI study positioned this drug as a first choice anticoagulant during percutaneous coronary interventions in patients with ST-elevation myocardial infarction. In fact the bivalirudin alone regimen, compared to unfractionated heparin plus GP2b3a inhibitors, decreased inhospital bleeding rates and short and long term mortality. Given the body of clinical evidence, bivalirudin is likely to contend to GP2b3a inhibitors the leading place among the proposed anticoagulation strategies in the setting of acute coronary syndromes. The duration of the bivalirudin infusion after PCI and the optimal oral antiplatelet regimen associated to bivalirudin are important issues to be solved in future randomized controlled studies.
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Lupi Alessandro, Rognoni Andrea, Cavallino Chiara, Secco Gioel G., Prando Maria D., Santagostino Matteo, Lazzero Maurizio, Cassetti Ettore and Bongo Angelo S., Pharmacological Adjuvant Therapies in Primary Coronary Interventions: Bivalirudin, Cardiovascular & Hematological Agents in Medicinal Chemistry 2013; 11 (2) . https://dx.doi.org/10.2174/1871525711311020006
DOI https://dx.doi.org/10.2174/1871525711311020006 |
Print ISSN 1871-5257 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6182 |
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