Document Detail


Safety and efficacy of bivalirudin in acute coronary syndromes.
MedLine Citation:
PMID:  18473866     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Antithrombotic and powerful antiplatelet therapies, in addition to early percutaneous coronary intervention (PCI) are considered the treatment of choice for moderate- to high-risk patients with acute coronary syndromes (ACS; unstable angina and non-ST-segment elevation myocardial infarction). However, despite the integration of newer therapies including stents, glycoprotein IIb/IIIa inhibitors (GPI), and thienopyridines, the rate of adverse ischemic events still remains unacceptably high. Intensive pharmacologic regimens used to stabilize the disrupted atherosclerotic plaque and support angioplasty as well as surgical revascularization procedures, elicit a high rate of bleeding complications. Recent trials (ACUITY and HORIZONS studies) added evidence regarding safety and efficacy of bivalirudin use in acute coronary syndromes. In summary, is has been shown that bivalirudin alone is safe and effective in the vast majority of patients suffering from acute coronary syndromes and being treated invasively. The cost-effectiveness of such an approach will have to be determined. It remains to be a matter of discussion whether there are still patient subgroups being in need of more aggressive treatment strategies including GPI. In practice, it might be reasonable to perform a baseline assessment of hemorrhagic risk facilitating the choice of an antithrombotic regimen with a favourable safety and efficacy profile. With this tailored therapy it might be possible to further improve outcomes for individual patients with ACS.
Authors:
F Hartmann
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current pharmaceutical design     Volume:  14     ISSN:  1873-4286     ISO Abbreviation:  Curr. Pharm. Des.     Publication Date:  2008  
Date Detail:
Created Date:  2008-05-13     Completed Date:  2008-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602487     Medline TA:  Curr Pharm Des     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1191-6     Citation Subset:  IM    
Affiliation:
University Hospital Lübeck, Medical Clinic 2, Ratzeburger Allee 160, 23538 Lübeck, Germany. Franz.Hartmann@uk-sh.de
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*
Angina, Unstable / drug therapy
Angioplasty, Transluminal, Percutaneous Coronary
Anticoagulants* / adverse effects,  therapeutic use
Fibrinolytic Agents / therapeutic use
Hemorrhage / chemically induced
Heparin / adverse effects,  therapeutic use
Hirudin Therapy
Hirudins* / adverse effects
Humans
Myocardial Infarction / drug therapy
Peptide Fragments* / adverse effects,  therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Recombinant Proteins / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin

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


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