Percutaneous coronary intervention in patients with acute coronary syndrome: focus on bivalirudin.
Previously, indirect thrombin inhibitors such as unfractionated heparin or low-molecular-weight heparin were used as a standard anticoagulation during percutaneous coronary intervention to prevent procedural thrombotic complications but at a risk of hemorrhagic complications. More recently, bivalirudin, a member of the direct thrombin inhibitor class, has been shown to have 1) predictable pharmacokinetics, 2) ability to inhibit free- and clot-bound thrombin, 3) no properties of platelet activation, 4) avoidance of heparin-induced thrombocytopenia, and 5) a significant reduction of bleeding without a reduction in thrombotic or ischemic endpoints compared to heparin and glycoprotein IIbIIIa inhibitors when used in patients presenting with acute coronary syndrome who are planned for an invasive treatment strategy.
Ramana
Ravi K
RK
Division of Cardiology, Loyola University Medical Center, Maywood, Illinois 60647, USA. rkramana@earthlink.net
Lewis
Bruce E
BE
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D000740:Anemia / Q000453:epidemiology; D000789:Angina, Unstable / Q000188:drug therapy / Q000503:physiopathology; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000991:Antithrombins / Q000494:pharmacology* / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000502:physiology; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D010446:Peptide Fragments / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin