Bivalirudin in percutaneous coronary intervention
Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2006-12-01
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| Series: | Vascular Health and Risk Management |
| Online Access: | https://www.dovepress.com/bivalirudin-in-percutaneous-coronary-intervention-peer-reviewed-article-VHRM |
| _version_ | 1811317173880094720 |
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| author | Sam J Lehman Derek P Chew |
| author_facet | Sam J Lehman Derek P Chew |
| author_sort | Sam J Lehman |
| collection | DOAJ |
| description | Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS). Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP) IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY) trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention |
| first_indexed | 2024-04-13T12:02:18Z |
| format | Article |
| id | doaj.art-034a9dfcbc2e40c396c84128eae12b2c |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-04-13T12:02:18Z |
| publishDate | 2006-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-034a9dfcbc2e40c396c84128eae12b2c2022-12-22T02:47:44ZengDove Medical PressVascular Health and Risk Management1178-20482006-12-01Volume 23573631437Bivalirudin in percutaneous coronary interventionSam J LehmanDerek P ChewSam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS). Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP) IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY) trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary interventionhttps://www.dovepress.com/bivalirudin-in-percutaneous-coronary-intervention-peer-reviewed-article-VHRM |
| spellingShingle | Sam J Lehman Derek P Chew Bivalirudin in percutaneous coronary intervention Vascular Health and Risk Management |
| title | Bivalirudin in percutaneous coronary intervention |
| title_full | Bivalirudin in percutaneous coronary intervention |
| title_fullStr | Bivalirudin in percutaneous coronary intervention |
| title_full_unstemmed | Bivalirudin in percutaneous coronary intervention |
| title_short | Bivalirudin in percutaneous coronary intervention |
| title_sort | bivalirudin in percutaneous coronary intervention |
| url | https://www.dovepress.com/bivalirudin-in-percutaneous-coronary-intervention-peer-reviewed-article-VHRM |
| work_keys_str_mv | AT samjlehman bivalirudininpercutaneouscoronaryintervention AT derekpchew bivalirudininpercutaneouscoronaryintervention |