title: Safety of  bivalirudin  in patients with coronary artery disease.
abstract: BACKGROUND
  Various limitations of unfractionated heparin (UFH) have triggered a search for new antithrombotic therapies for patients with coronary artery disease (CAD). Bivalirudin is a direct thrombin inhibitor with several pharmacological advantages over UFH and is currently endorsed by practice guidelines, particularly in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI). To maximize effectiveness of an antithrombotic regimen and reduce complications, both ischemic and bleeding risks should be known when an antithrombotic strategy is chosen.
  
  
  METHODS
  This review focuses on the safety and tolerability of bivalirudin in patients with CAD in the setting of currently approved indications. Synthesis of evidence has been made from clinical trials, systematic reviews, meta-analyses and registries (1992 - 2011). The reader is provided with an overview of pharmacological properties of bivalirudin and its efficacy, with special emphasis on its safety in patients with CAD.
  
  
  CONCLUSIONS
  Bivalirudin has an impressive safety profile in CAD patients treated with PCI. Bivalirudin is the antithrombotic of choice in suspected or verified heparin-induced thrombocytopenia. For ST elevation myocardial infarction patients undergoing primary PCI, bivalirudin should become the preferred antithrombotic agent together with early institution of antiplatelet therapy.
authors: Herzzentrum, Segeberger Kliniken GmbH, Am Kurpark 1, 23795 Bad Segeberg, Germany. mohamed.abdel-wahab@segebergerkliniken.de
authors: Mohamed
authors: M
authors: Abdel-Wahab
authors: Gert
authors: G
authors: Richardt
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000991:Antithrombins / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000009:adverse effects* / Q000494:pharmacology; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy; D010446:Peptide Fragments / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin