Clinical pharmacology of bivalirudin.
Much progress has been made in understanding and treating acute coronary syndromes. For patients undergoing percutaneous transluminal coronary angioplasty, anticoagulant therapy during the procedure must strike a balance between providing sufficient anticoagulation to prevent thrombus formation and ischemic complications while averting hemorrhagic complications. Bivalirudin, a thrombin-specific anticoagulant, is the only anticoagulant that reduces both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is easy to use, provides predictable anticoagulation, inactivates both free and clot-bound thrombin, and blocks thrombin-mediated platelet activation and aggregation. Drug-drug interaction studies have found no clinically relevant interactions between bivalirudin and ticlopidine, abciximab, tirofiban, or eptifibatide. Bivalirudin is well tolerated by patients who previously received low-molecular-weight heparin (LMWH), when LMWH is discontinued 8-14 hours before bivalirudin is started. Similarly, switching from heparin to bivalirudin at the time of PCI reduces both ischemic and bleeding events.
Reed
Michael D
MD
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. mdr2@po.cwru.edu
Bell
Dawn
D
D000789:Angina, Unstable / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D000991:Antithrombins / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003328:Coronary Thrombosis / Q000517:prevention & control; D004347:Drug Interactions; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology; D006493:Heparin / Q000009:adverse effects / Q000494:pharmacology; D006629:Hirudins / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000494:pharmacology*; D006801:Humans; D010446:Peptide Fragments / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011994:Recombinant Proteins / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced; D013988:Ticlopidine / Q000494:pharmacology
D000925:Anticoagulants; D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D006493:Heparin; D013988:Ticlopidine; C074619:bivalirudin