title: New Approaches to the Role of Thrombin in Acute Coronary Syndromes: Quo Vadis Bivalirudin, a Direct Thrombin Inhibitor?
abstract: The pathophysiology of acute coronary syndrome (ACS) involves platelet activation and thrombus formation after the rupture of atherosclerotic plaques. Thrombin is generated at the blood-plaque interface in association with cellular membranes on cells and platelets. Thrombin also amplifies the response to the tissue injury, coagulation and platelet response, so the treatment of ACS is based on the combined use of both antiplatelet (such as aspirin, clopidogrel, prasugrel and ticagrelor) and antithrombotic drugs (unfractionated heparin, enoxaparin, fondaparinux and bivalirudin). Bivalirudin competitively inhibits thrombin with high affinity, a predictable response from its linear pharmacokinetics and short action. However, a present remarkable controversy exists between the latest main Guidelines in Clinical Practice and the key trials evaluating the use of bivalirudin in ACS. The aim of this review is to update the development of bivalirudin, including pharmacological properties, obtained information from clinical trials evaluating efficacy and safety of bivalirudin in ACS; as well as the recommendations of clinical Guidelines.
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, Murcia 30120, Spain. masunep@gmail.com.
authors.forename: María Asunción
authors.initials: MA
authors.lastname: Esteve-Pastor
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, Murcia 30120, Spain. dianahr@um.es.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Romero
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, Murcia 30120, Spain. mvch@valdeschavarri.e.telefonica.net.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, Murcia 30120, Spain. fcomarino@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000378:metabolism* / Q000503:physiopathology; D000925:Anticoagulants / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005260:Female; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000494:pharmacology* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors / Q000378:metabolism*
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D013917:Thrombin; C074619:bivalirudin
keywords: ACS; STEMI; bivalirudin; non-STEMI; thrombin