Abstract
For decades, unfractionated heparin (UFH) has been widely used in catheterization laboratories for anticoagulation for percutaneous coronary intervention (PCI). The direct thrombin inhibitors, bivalirudin, has emerged as an alternative to UFH for PCI procedures, due to its lower bleeding risk. More recently, randomized trials and meta-analyses questioned the efficacy of bivalirudin, and demonstrated that bivalirudin might be associated with a higher incidence of ischemic events and in particular stent thrombosis. In this review, we discuss the pharmacology of bivalirudin along with the clinical evidence comparing bivalirudin versus UFH in patients undergoing PCI for various indications.
Keywords:
Bivalirudin; Percutaneous coronary intervention; Revascularization.
© 2015 John Wiley & Sons Ltd.
MeSH terms
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Acute Coronary Syndrome / blood
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Acute Coronary Syndrome / diagnosis
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Acute Coronary Syndrome / economics
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Acute Coronary Syndrome / mortality
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Acute Coronary Syndrome / therapy*
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Animals
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Anticoagulants / adverse effects
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Anticoagulants / economics
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Anticoagulants / therapeutic use*
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Coronary Thrombosis / etiology
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Cost-Benefit Analysis
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Drug Costs
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Hemorrhage / chemically induced
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Heparin / therapeutic use
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Hirudins / adverse effects
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Hirudins / economics
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Humans
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Myocardial Infarction / blood
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Myocardial Infarction / diagnosis
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Myocardial Infarction / economics
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Myocardial Infarction / mortality
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Myocardial Infarction / therapy*
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Peptide Fragments / adverse effects
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Peptide Fragments / economics
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Peptide Fragments / therapeutic use*
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Percutaneous Coronary Intervention* / adverse effects
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Percutaneous Coronary Intervention* / economics
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Percutaneous Coronary Intervention* / mortality
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Recombinant Proteins / adverse effects
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Recombinant Proteins / economics
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Recombinant Proteins / therapeutic use
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Risk Assessment
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Risk Factors
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Treatment Outcome
Substances
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Anticoagulants
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Hirudins
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Peptide Fragments
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Recombinant Proteins
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Heparin
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bivalirudin