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Bivalirudin for acute coronary syndromes: premises, promises and doubts.
- Source :
-
Thrombosis and haemostasis [Thromb Haemost] 2015 Apr; Vol. 113 (4), pp. 698-707. Date of Electronic Publication: 2014 Dec 18. - Publication Year :
- 2015
-
Abstract
- Bivalirudin is a valuable anticoagulant option in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention. Advantages over heparin as a parenteral anticoagulant include more predictable pharmacokinetics and pharmacodynamics, shorter half-life, no need for cofactors, some degree of antiplatelet effect, and the ability to inhibit clot-bound thrombin. Clinical evidence supporting the use of bivalirudin over heparin in current ACS guidelines, however, derives mostly from early randomised trials that may no longer reflect current management patterns, now including the use of oral antiplatelet agents more potent than clopidogrel (i.e. prasugrel or ticagrelor) and a broader implementation of strategies to reduce bleeding (i.e. radial access for percutaneous coronary intervention, and use of glycoprotein IIb/IIIa inhibitors only in bailout situations). Defining the fine balance between bivalirudin efficacy and safety over heparins in the context of other antithrombotic treatments remains a challenge in clinical practice, particularly in a fast-evolving scenario, such as ACS, where numerous new trials have been presented in very recent times. Here we provide an up-to-date overview of the evidence on the use of bivalirudin in ACS, with focus on new data, open issues, and future directions.
- Subjects :
- Acute Coronary Syndrome blood
Acute Coronary Syndrome diagnosis
Acute Coronary Syndrome economics
Acute Coronary Syndrome mortality
Anticoagulants adverse effects
Anticoagulants economics
Anticoagulants pharmacokinetics
Cost-Benefit Analysis
Drug Costs
Hemorrhage chemically induced
Hirudins adverse effects
Hirudins economics
Hirudins pharmacokinetics
Humans
Myocardial Infarction blood
Myocardial Infarction diagnosis
Myocardial Infarction economics
Myocardial Infarction mortality
Peptide Fragments adverse effects
Peptide Fragments economics
Peptide Fragments pharmacokinetics
Recombinant Proteins adverse effects
Recombinant Proteins economics
Recombinant Proteins pharmacokinetics
Recombinant Proteins therapeutic use
Risk Assessment
Risk Factors
Treatment Outcome
Acute Coronary Syndrome therapy
Anticoagulants therapeutic use
Myocardial Infarction therapy
Peptide Fragments therapeutic use
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention economics
Percutaneous Coronary Intervention mortality
Subjects
Details
- Language :
- English
- ISSN :
- 2567-689X
- Volume :
- 113
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Thrombosis and haemostasis
- Publication Type :
- Academic Journal
- Accession number :
- 25519159
- Full Text :
- https://doi.org/10.1160/TH14-09-0765