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Bivalirudin: a direct thrombin inhibitor.

Timothy D Gladwell1

  • 1Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania 15282, USA. gladwell@duq.edu

Clinical Therapeutics
|February 9, 2002
PubMed
Summary

Bivalirudin, a direct thrombin inhibitor, shows similar efficacy to unfractionated heparin but with lower bleeding rates in percutaneous coronary interventions. Its use is recommended for patients with heparin-induced thrombocytopenia due to high cost and limited long-term data.

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Area of Science:

  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Hirudin, a leech-derived anticoagulant, inspired the development of direct thrombin inhibitors like bivalirudin.
  • Bivalirudin is FDA-approved for anticoagulation in unstable angina patients undergoing percutaneous transluminal coronary angioplasty.

Purpose of the Study:

  • Review pharmacologic properties of bivalirudin.
  • Evaluate efficacy and tolerability of bivalirudin in ischemic coronary syndromes.
  • Assess potential cost-effectiveness of bivalirudin.

Main Methods:

  • Searched MEDLINE, International Pharmaceutical Abstracts, and Iowa Drug Information Service (1966-September 2001).
  • Used keywords: bivalirudin and Hirulog.
  • Reviewed reference lists of retrieved articles.

Main Results:

  • Bivalirudin directly inhibits thrombin; peak plasma concentrations occur within 2 minutes.
  • Achieved a median activated clotting time of 346 seconds with low variability.
  • Demonstrated equivalent efficacy and lower bleeding rates (P < 0.001) compared to unfractionated heparin (UFH) in percutaneous coronary interventions.
  • Showed no mortality reduction but lower reinfarction rates (P < 0.001) versus heparin in acute myocardial infarction when added to aspirin and streptokinase.
  • Limited experience in unstable angina, heparin-induced thrombocytopenia (HIT), and with glycoprotein IIb/IIIa inhibitors.

Conclusions:

  • Bivalirudin offers lower bleeding rates than UFH in PCI.
  • Consider bivalirudin as an alternative for patients with HIT.
  • Further clinical trials are needed to clarify efficacy and safety benefits, especially given its high cost.

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