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Clinical Pharmacology of Bivalirudin
Author(s) -
Reed Michael D.,
Bell Dawn
Publication year - 2002
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.22.10.105s.33616
Subject(s) - bivalirudin , medicine , abciximab , conventional pci , anticoagulant , eptifibatide , cardiology , heparin , percutaneous coronary intervention , discovery and development of direct thrombin inhibitors , direct thrombin inhibitor , low molecular weight heparin , thrombin , anesthesia , myocardial infarction , warfarin , platelet , dabigatran , atrial fibrillation
Much progress has been made in understanding and treating acute coronary syndromes. For patients undergoing percutaneous transluminal coronary angioplasty, anticoagulant therapy during the procedure must strike a balance between providing sufficient anticoagulation to prevent thrombus formation and ischemic complications while averting hemorrhagic complications. Bivalirudin, a thrombin‐specific anticoagulant, is the only anticoagulant that reduces both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is easy to use, provides predictable anticoagulation, inactivates both free and clot‐bound thrombin, and blocks thrombin‐mediated platelet activation and aggregation. Drug‐drug interaction studies have found no clinically relevant interactions between bivalirudin and ticlopidine, abciximab, tirofiban, or eptifibatide. Bivalirudin is well tolerated by patients who previously received low‐molecular‐weight heparin (LMWH), when LMWH is discontinued 8–14 hours before bivalirudin is started. Similarly, switching from heparin to bivalirudin at the time of PCI reduces both ischemic and bleeding events.