title: Bivalirudin in acute coronary syndromes and percutaneous coronary intervention: should we use it?
abstract: Major bleeding remains a major risk factor for percutaneous coronary intervention of acute coronary syndromes and is associated with higher morbidity, mortality, prolonged hospital stay and costs. With the recognition that bleeding is an important factor in patient outcomes, the prevention of bleeding has become as important a goal as the prevention of ischaemia. The direct thrombin inhibitor bivalirudin has been shown to reduce ischaemia and importantly, is associated with less bleeding. In this article we review the evidence base that supports the use of bivalirudin across all spectrums of coronary syndromes and percutaneous coronary intervention. An algorithm for the use of bivalirudin in high risk subgroups and coronary syndromes is suggested.
authors.affiliation: Hollywood Hospital, Cardiology, Nedlands, WA 6009, Australia. Electronic address: yuliten@yahoo.com.au.
authors.forename: Yuli
authors.initials: Y
authors.lastname: Ten
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000465:Algorithms; D000991:Antithrombins / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D007902:Length of Stay; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Antithrombin agent; Bivalirudin; Bleeding; Glycoprotein IIbIIIa inhibitor (GP IIbIIIa inhibitor); Percutaneous coronary intervention