We read with great interest the letter to the Editor entitled ‘Bivalirudin infusion in patients with acute coronary syndrome after stenting’ [Citation1]. The authors highlight the increased risk of stent thrombosis within the hours following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients treated with bivalirudin. In their letter referring to our review article, they emphasize the potential benefit of a prolonged infusion of bivalirudin at the right dosage to prevent adverse outcomes [Citation2].
We totally agree with their comments. In fact, we previously demonstrated that an intravenous (IV) bolus of bivalirudin 0.75 mg/kg followed by a 1.75 mg/kg/h infusion resulted in a significantly lower antithrombotic activity (determined with activated partial thromboplastin time (aPTT)) during PCI compared with a 70 IU/kg bolus of unfractionated heparin (UFH) in ACS patients [Citation3]. Further, this lower anticoagulant property combined to a reduced half-life result in a shorter inhibition of thrombin generation that returns to baseline 4 h after the end of the infusion of bivalirudin while a bolus of UFH during PCI has a prolonged effect on this biological parameters [Citation4].
We agree that the question of the optimal anticoagulant regimen during and after PCI in ACS patients remains unanswered and has to be investigated by well-designed randomized trials.
Declaration of interest
The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
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References
- Li W, Mai L, Cai X, et al. Bivalirudin infusion in patients with acute coronary syndrome after stenting. Expert Opin Pharmacother. 2019. DOI:10.1080/14656566.2019.1615329. [Epub ahead of print]
- Laine M, Lemesle G, Dabry T, et al. Bivalirudin during percutaneous coronary intervention in acute coronary syndromes. Expert Opin Pharmacother. 2019;20:295–304.
- Frere C, Laine M, Lemesle G, et al. Antithrombotic efficacy of bivalirudin compared to unfractionated heparin during percutaneous coronary intervention for acute coronary syndrome. Platelets. 2019;30:105–111.
- Laine M, Frere C, Cuisset T, et al. Potential mechanism of acute stent thrombosis with bivalirudin following percutaneous coronary intervention in acute coronary syndromes. Int J Cardiol. 2016;220:496–500.