title: Optimal anticoagulation prior to cath: Bivalirudin vs. Heparin the saga continues….
abstract: During the pre-procedural (medication) phase, the use of bivalirudin monotherapy is associated with the lowest rate of bleeding in patients with Non-ST elevation myocardial infarction (Non-STEMI) undergoing an early invasive strategy. Monotherapy with either bivalirudin or unfractionated heparin (UFH) appear interchangeable in this setting. The use of GPI upstream with either drug should be discouraged due to an increased risk of bleeding and net adverse events. The use of low dose aspirin plus potent P2Y12 inhibitors followed by a transradial approach with implantation of drug-eluting coronary stents with fluorinated polymers represents an strategy that may help limit perioperative ischemic and hemorrhagic complications in these individuals.
authors.affiliation: Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular De Buenos Aires, Ciudad Autónoma De Buenos Aires, Argentina.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Belardi
authors.affiliation: Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular De Buenos Aires, Ciudad Autónoma De Buenos Aires, Argentina.
authors.forename: Mariano
authors.initials: M
authors.lastname: Albertal
mesh_terms: D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments; D062645:Percutaneous Coronary Intervention; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin
keywords: acute coronary syndromes; bivalirudin; medication phase; percutaneous coronary interventions; unfractionated heparin