English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Bivalirudin is an interesting new intravenous direct thrombin inhibitor with already welldocumented efficacy. It is predominantly used in the cardiac catheterisation laboratory during percutaneous coronary interventions. In contrast to hirudin, which failed in this setting, bivalirudin has a shorter half-life and much less immunogenicity. Bivalirudin lacks the risk of heparin-induced thrombocytopenia and shows a tendency to lower bleeding risks without reduction of efficacy when compared with combining unfractionated heparin and glycoprotein IIb/IIIa inhibitors (common in the United States but not in Europe). Improved efficacy compared with the use of unfractionated heparin without glycoprotein IIb/IIIa inhibitors (the rule in Europe) is likely but not proved. Due to its short half-life, and some data showing its safety during cardiac surgery, there is no particular concern for patients needing immediate heart surgery after a percutaneous coronary intervention. Bivalirudin can be used on the background of any other anticoagulant save vitamin K antagonists, which have not been examined in this context. The ideal doses have been sufficiently determined as have been the dosage reductions recommended in patients with mild to moderate renal failure. Safety in patients without renal function has not been assessed. The metabolism of bivalirudin occurs by proteolysis and no interactions with drugs employing cytochrome P 450 are to be expected. No other interactions with common drugs in cardiovascular disease have been observed to date. Bivalirudin is a real asset for patients with thrombocytopenia or a history thereof undergoing coronary interventions. Some interventional cardiologists may take advantage of the slightly more favourable outcome in patients with bivalirudin compared with patients with unfractionated heparin plus glycoprotein IIb/IIIa inhibitors but most will probably continue to use glycoprotein IIb/IIIa inhibitors in risky cases, thereby eliminating this theoretical advantage of bivalirudin. Safety concerns are not to be expected. Considering policies in European catheterisation laboratories, an increase in cost will occur if bivalirudin replaces unfractionated heparin in routine cases of interventional cardiology.

Bivalirudin, the new kid on the block in coronary interventions