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Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...
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Related Experiment Video

Updated: Apr 5, 2026

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
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Bivalirudin: An expensive heparin?

Saurabh Gupta1, Joaquin E Cigarroa1

  • 1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 16, 2015
PubMed
Summary

Unfractionated heparin (UH) shows similar bleeding and ischemic event rates compared to bivalirudin. Optimized UH dosing may match bivalirudin

Area of Science:

  • Cardiovascular medicine
  • Pharmacology
  • Interventional cardiology

Background:

  • Bivalirudin has historically demonstrated improved safety over unfractionated heparin (UH) in certain clinical trials, particularly regarding bleeding events.
  • The use of glycoprotein IIb/IIIa inhibitors concurrently with anticoagulants can influence bleeding and ischemic outcomes.
  • Optimizing heparin dosing and monitoring, such as using activated clotting time (ACT), is crucial for balancing efficacy and safety.

Discussion:

  • This study compares bleeding and ischemic event rates between unfractionated heparin (UH) and bivalirudin, excluding concomitant glycoprotein IIb/IIIa inhibitor use.
  • Findings suggest that similar bleeding rates are observed with UH compared to bivalirudin when glycoprotein IIb/IIIa inhibitors are not used.
  • Ischemic event rates during the index hospitalization were also comparable between the UH and bivalirudin groups.

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Key Insights:

  • Unfractionated heparin (UH), when used without glycoprotein IIb/IIIa inhibitors, demonstrates comparable bleeding rates to bivalirudin.
  • Ischemic event rates during the index hospitalization are similar for both unfractionated heparin and bivalirudin.
  • A low-dose unfractionated heparin regimen (60-70 units/kg) targeting an activated clotting time (ACT) of 200-250 seconds may achieve safety outcomes similar to bivalirudin.

Outlook:

  • Further research should explore the long-term outcomes and cost-effectiveness of optimized unfractionated heparin regimens compared to bivalirudin.
  • Investigating the impact of different ACT targets and heparin dosing strategies in diverse patient populations is warranted.
  • These findings may influence current guidelines and clinical practice regarding anticoagulant selection in periprocedural settings.