Percutaneous coronary intervention in patients with acute coronary syndrome: focus on bivalirudin

Abstract

Previously, indirect thrombin inhibitors such as unfractionated heparin or low-molecular-weight heparin were used as a standard anticoagulation during percutaneous coronary intervention to prevent procedural thrombotic complications but at a risk of hemorrhagic complications. More recently, bivalirudin, a member of the direct thrombin inhibitor class, has been shown to have 1) predictable pharmacokinetics, 2) ability to inhibit free- and clot-bound thrombin, 3) no properties of platelet activation, 4) avoidance of heparin-induced thrombocytopenia, and 5) a significant reduction of bleeding without a reduction in thrombotic or ischemic endpoints compared to heparin and glycoprotein IIbIIIa inhibitors when used in patients presenting with acute coronary syndrome who are planned for an invasive treatment strategy.

Keywords:

• bivalirudin
• coronary intervention
• direct thrombin inhibitor
• acute coronary syndrome

Acknowledgements

The authors would like to thank Dr. John F. Moran, M.D. for his review of this manuscript.

Disclosures

The authors have no conflicts of interest to disclose.