title: Use of prolonged bivalirudin infusions following percutaneous coronary intervention.
abstract: BACKGROUND
  Antithrombotic therapy plays an integral role in percutaneous coronary intervention (PCI). Bivalirudin has been evaluated in elective procedures and across the spectrum of acute coronary syndromes and is associated with decreased bleeding events compared to unfractionated heparin (UFH) in combination with glycoprotein IIb/IIIa inhibitors (GPI) when used for the duration of PCI. The use of bivalirudin beyond the end of PCI is not as well established but is being explored as an option for specific patients.
  
  
  CONCLUSIONS
  A small increase in stent thrombosis and ischemic events has been identified in large clinical trials using bivalirudin for acute coronary syndromes (ACS). The reasons for this finding are unclear, but may be related to the short duration of bivalirudin or the timing and dose of antiplatelet therapies in the trials. Two small, single center trials have evaluated bivalirudin continued for 4 h beyond the end of PCI. These trials suggest that prolonged bivalirudin infusions result in less periprocedural myocardial infarction with no increase in bleeding compared to intraprocedural only bivalirudin. However, these studies were not powered to identify a difference in bleeding. Efforts to decrease periprocedural myocardial infarction should include the appropriate use of oral antiplatelet agents. An adequate and appropriately timed loading dose of thienopyridines plays a key role in decreasing complications of PCI.
  
  
  CONCLUSIONS
  The strategy of prolonging the bivalirudin infusion at a reduced infusion rate for 4 h after completion of the PCI procedure was explored and offers promising results.
authors.affiliation: Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA. lynette.moser@wayne.edu
authors.forename: Lynette R
authors.initials: LR
authors.lastname: Moser
authors.forename: Carrie W
authors.initials: CW
authors.lastname: Nemerovski
authors.forename: Kelley L
authors.initials: KL
authors.lastname: Good
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D010446:Peptide Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin