Document Detail


Pharmacological and clinical profile of bivalirudin in the treatment of patients with acute coronary syndrome.
MedLine Citation:
PMID:  19416088     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Bivalirudin is a direct thrombin inhibitor with several pharmacological advantages over heparin. It has been studied extensively in non-ST elevation acute 60 coronary syndromes (NSTE-ACS) and in percutaneous coronary intervention. Bivalirudin has also recently been investigated in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty and stenting. More than 27,000 patients were randomized in these trials. OBJECTIVE: To provide an overview of the pharmacological properties of bivalirudin and its efficacy and safety profile in patients across the spectrum of acute coronary syndromes (ACS). METHODS: All published, peer-reviewed clinical trials were reviewed and as relevant were included. RESULTS AND CONCLUSIONS: Bivalirudin with provisional IIb/IIIa antagonists provides consistent results across the full spectrum of ACS, with similar or non-inferior protection from ischemic events and significantly reduces bleeding complications compared with heparin and IIb/IIIa antagonists. In STEMI, mortality at 30 days and 1 year is significantly reduced. The unique pharmacokinetic profile of bivalirudin allows for simultaneous reductions in both ischemic and hemorrhagic events and makes it an appropriate alternative to heparin.
Authors:
Harvey D White
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Expert opinion on drug metabolism & toxicology     Volume:  5     ISSN:  1744-7607     ISO Abbreviation:  Expert Opin Drug Metab Toxicol     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-06     Completed Date:  2009-07-08     Revised Date:  2009-11-16    
Medline Journal Info:
Nlm Unique ID:  101228422     Medline TA:  Expert Opin Drug Metab Toxicol     Country:  England    
Other Details:
Languages:  eng     Pagination:  529-38     Citation Subset:  IM    
Affiliation:
Coronary Care & Green Lane Cardiovascular Research Unit, Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand. HarveyW@adhb.govt.nz
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*,  mortality
Angioplasty, Transluminal, Percutaneous Coronary / methods
Anticoagulants / economics,  pharmacology,  therapeutic use*
Cost-Benefit Analysis
Hemorrhage / chemically induced
Heparin / adverse effects,  therapeutic use
Hirudins / economics,  pharmacology
Humans
Myocardial Infarction / drug therapy,  mortality
Peptide Fragments / economics,  pharmacology,  therapeutic use*
Randomized Controlled Trials as Topic
Recombinant Proteins / economics,  pharmacology,  therapeutic use
Thrombin / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin; EC 3.4.21.5/Thrombin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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