title: Bivalirudin in percutaneous coronary intervention, is it the anticoagulant of choice?
abstract: For decades, unfractionated heparin (UFH) has been widely used in catheterization laboratories for anticoagulation for percutaneous coronary intervention (PCI). The direct thrombin inhibitors, bivalirudin, has emerged as an alternative to UFH for PCI procedures, due to its lower bleeding risk. More recently, randomized trials and meta-analyses questioned the efficacy of bivalirudin, and demonstrated that bivalirudin might be associated with a higher incidence of ischemic events and in particular stent thrombosis. In this review, we discuss the pharmacology of bivalirudin along with the clinical evidence comparing bivalirudin versus UFH in patients undergoing PCI for various indications.
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Ahmed
authors: A
authors: Mahmoud
authors: Department of Medicine, Seton Hall University School of Health and Medical Sciences, Trinitas Regional Medical Center, Elizabeth, NJ, USA.
authors: Marwan
authors: M
authors: Saad
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Akram Y
authors: http://orcid.org/0000-0001-9853-7591
authors: AY
authors: Elgendy
authors: Department of Medicine, Creighton University, Omaha, NE, USA.
authors: Ahmed
authors: A
authors: Abuzaid
authors: Department of Medicine, University of Florida, Gainesville, FL, USA.
authors: Islam Y
authors: IY
authors: Elgendy
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003328:Coronary Thrombosis / Q000209:etiology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins / Q000009:adverse effects / Q000191:economics; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D010446:Peptide Fragments / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: Bivalirudin; Percutaneous coronary intervention; Revascularization