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Heparin, bivalirudin, or the best of both for STEMI interventions
Author(s) -
Gilchrist Ian C.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28091
Subject(s) - bivalirudin , medicine , heparin , conventional pci , anticoagulant , discovery and development of direct thrombin inhibitors , direct thrombin inhibitor , cardiology , adverse effect , intensive care medicine , thrombin , warfarin , myocardial infarction , atrial fibrillation , platelet , dabigatran
Key Points Whether heparin, bivalirudin, or bivalirudin delivered on the background of prior heparin therapy, during primary PCI therapy is associated with a better outcome is difficult to ascertain from any one study. Meta‐analysis of available trials suggests that the use of bivalirudin on top of prior heparin therapy may be associated with the lowest all‐cause mortality and major adverse cardiovascular events while preserving much of the access site bleeding reduction of bivalirudin alone. There may be a role for initial therapy of STEMI with a broad‐spectrum anticoagulant such as heparin that is then focused to a more specific direct‐thrombin inhibitor (bivalirudin) in primary PCI.