Bivalirudin in peripheral interventions.
The discovery of heparin and its eventual incorporation into many therapeutic and diagnostic procedures has made this agent ubiquitous in the fields of cardiac and vascular medicine. Heparin however does have a significant complication and side-effect profile that includes both bleeding as well as vessel thrombosis through the development of heparin-induced thrombocytopenia. The recent addition of direct thrombin inhibitors, for example, bivalirudin, to the anticoagulation armaterium has produced favorable outcomes. Most of the experience with bivalirudin has been in coronary interventions and only recently have more interventionalists been turning to this agent as the sole anticoagulant for peripheral interventions even in patients who could tolerate heparin. In this review, we describe our experience with bivalirudin in peripheral interventions emphasizing how we dose and monitor this drug. In addition, this article discusses the findings in existing clinical trials involving bivalirudin.
Maclean
Alexandra A
AA
Department of Surgery, New York Hospital-Queens, Flushing, New York, USA.
Peña
Constantino S
CS
Katzen
Barry T
BT
D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D010446:Peptide Fragments / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015642:Radiology, Interventional; D011994:Recombinant Proteins / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin