Pharmacological and clinical profile of bivalirudin in the treatment of patients with acute coronary syndrome.
BACKGROUND
Bivalirudin is a direct thrombin inhibitor with several pharmacological advantages over heparin. It has been studied extensively in non-ST elevation acute 60 coronary syndromes (NSTE-ACS) and in percutaneous coronary intervention. Bivalirudin has also recently been investigated in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty and stenting. More than 27,000 patients were randomized in these trials.


OBJECTIVE
To provide an overview of the pharmacological properties of bivalirudin and its efficacy and safety profile in patients across the spectrum of acute coronary syndromes (ACS).


METHODS
All published, peer-reviewed clinical trials were reviewed and as relevant were included.


CONCLUSIONS
Bivalirudin with provisional IIb/IIIa antagonists provides consistent results across the full spectrum of ACS, with similar or non-inferior protection from ischemic events and significantly reduces bleeding complications compared with heparin and IIb/IIIa antagonists. In STEMI, mortality at 30 days and 1 year is significantly reduced. The unique pharmacokinetic profile of bivalirudin allows for simultaneous reductions in both ischemic and hemorrhagic events and makes it an appropriate alternative to heparin.
Coronary Care & Green Lane Cardiovascular Research Unit, Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand. HarveyW@adhb.govt.nz
Harvey D
HD
White
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000925:Anticoagulants / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006629:Hirudins / Q000191:economics / Q000494:pharmacology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D010446:Peptide Fragments / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; D013917:Thrombin; C074619:bivalirudin