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Can bivalirudin and provisional GP IIb/IIIa blockade REPLACE heparin and planned glycoprotein IIb/IIIa blockade

Sheila Doggrell1

  • 1School of Biomedical Sciences, University of Queensland, QLD 4072, Australia. s_doggrell@yahoo.com

Expert Opinion on Pharmacotherapy
|July 25, 2003
PubMed

The combined use of low dose heparin and glycoprotein (GP) IIb/IIIa blockers is standard treatment during percutaneous coronary interventions (PCIs). Bivalirudin has a different mechanism of anticoagulant action than heparin. In REPLACE-2, patients undergoing PCI were randomised to bivalirudin with provisional GP IIb/IIIa blockade or heparin and planned GP IIb/IIIa blockade. The primary quadruple composite end point was death, myocardial infarction, urgent repeat revascularisation or in-hospital major bleeding by 30 days, and statistical analysis showed that bivalirudin was not inferior to heparin plus GP IIb/IIIa blockade. There were fewer major and minor bleeding events with bivalirudin than with heparin plus GP IIb/IIIa blockade. Bivalirudin and provisional GP IIb/IIIa blockade should now be considered as an alternative to heparin plus planned GP IIb/IIIa blockade in patients undergoing urgent or elective revascularisation.

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