Bivalirudin: a review of the pharmacology and clinical application

Abstract

Among the current agents in the class of direct thrombin inhibitors, bivalirudin (Angiomax^®, The Medicines Company, NJ, USA) has seen increased use in cardiovascular medicine over the past decade through its primary indication as an anticoagulant used during percutaneous coronary interventions. Bivalirudin has been further investigated and used as the anticoagulation strategy in the setting of cardiac and endovascular surgical procedures and is frequently utilized in the management of patients with heparin-induced thrombocytopenia. In comparison with heparin, bivalirudin exhibits a low immunogenic profile and provides similar or reduced major bleeding rates as well as a predictable degree of anticoagulation that is dose related. Bivalirudin primarily undergoes dual elimination via proteolytic cleavage and renal elimination, and requires dose adjustment in the setting of severe renal dysfunction. Given the body of supportive data, bivalirudin is likely to continue to figure prominently as a reliable and efficient anticoagulation strategy. Additional agents in the class of direct thrombin inhibitors are under investigation and may find increasing clinical use.

Keywords::

• acute coronary syndrome
• anti-thrombotic
• bivalirudin
• direct thrombin inhibitor(s)

Financial & competing interests disclosure

Sunil V Rao has received research funding from Cordis Corporation and Portola Pharmaceuticals, and has acted as a consultant for Bristol Myers Squibb, sanofi-aventis, Astra Zeneca and The Medicines Company; E Magnus Ohman reports affiliation with Bristol-Myers Squibb, CV Therapeutics, Daiichi Sankyo, Datascope, Eli Lilly & Company, sanofi-aventis, Schering-Plough and The Medicines Company. E Magnus Ohman also reports consulting honoraria from Abiomed, AstraZeneca, CV Therapeutics, Datascope, Gilead Sciences, Liposcience, Northpoint Domain, Pozen Inc., Response Biomedical, The Medicines Company and WebMD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.