PMID- 14521034
OWN - NLM
STAT- MEDLINE
DCOM- 20040114
LR  - 20190222
IS  - 1079-2082 (Print)
IS  - 1079-2082 (Linking)
VI  - 60
IP  - 18
DP  - 2003 Sep 15
TI  - Bivalirudin in percutaneous coronary intervention.
PG  - 1841-9
AB  - The chemistry and pharmacology, pharmacokinetics, pharmacodynamics, adverse 
      effects, drug interactions, dosing and administration, and pharmacoeconomics of 
      bivalirudin are reviewed; clinical trials of bivalirudin's application in 
      percutaneous coronary intervention (PCI) are also discussed. Bivalirudin is a 
      direct thrombin inhibitor approved for use in PCI. It reversibly binds to 
      thrombin's catalytic site and substrate recognition site and blocks both 
      circulating and fibrin-bound thrombin. Peak concentrations occur in less than 5 
      minutes after bolus-dose administration, and its half-life is approximately 25 
      minutes. It is primarily eliminated renally, and dosage reduction may be required 
      in patients with severe renal dysfunction. Two clinical trials have demonstrated 
      that bivalirudin is at least as effective as unfractionated heparin (UFH) in 
      preventing ischemic complications in PCI. Other trials have shown that 
      bivalirudin has beneficial ischemic and hemorrhagic outcomes in a more modern PCI 
      setting (i.e., intracoronary stent placement, clopidogrel, and glycoprotein 
      IIb/IIIa-receptor inhibitors). Bivalirudin combined with provisional glycoprotein 
      IIb/IIIa inhibitors was noninferior to UFH with planned glycoprotein IIb/IIIa 
      inhibitors and superior to UFH alone with respect to ischemic and hemorrhagic 
      endopoints in PCI. Major bleeding with bivalirudin has occurred in approximately 
      3% of patients in clinical trials, and it is not known to have any interactions 
      with the cytochrome P-450 isoenzyme system. The acquisition cost of bivalirudin 
      in one study was less than the combination of UFH and glycoprotein IIb/IIIa 
      inhibitors. Bivalirudin combined with provisional glycoprotein IIb/IIIa 
      inhibitors appears to be an acceptable alternative to the standard of care and is 
      superior to UFH alone in PCI.
FAU - Caron, Michael F
AU  - Caron MF
AD  - Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, 
      Kingston, USA. mcaron@uri.edu
FAU - McKendall, George R
AU  - McKendall GR
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - EC 3.4.21.5 (Thrombin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Disease
MH  - *Angioplasty, Balloon, Coronary/adverse effects
MH  - Clinical Trials as Topic
MH  - Coronary Disease/therapy
MH  - Drug Interactions
MH  - Fibrinolytic Agents/economics/pharmacokinetics/*therapeutic use
MH  - Hirudins/*analogs & derivatives/economics/pharmacokinetics
MH  - Humans
MH  - Peptide Fragments/economics/pharmacokinetics/*therapeutic use
MH  - Recombinant Proteins/economics/pharmacokinetics/*therapeutic use
MH  - Thrombin/*antagonists & inhibitors
MH  - Thrombosis/etiology/prevention & control
RF  - 39
EDAT- 2003/10/03 05:00
MHDA- 2004/01/15 05:00
CRDT- 2003/10/03 05:00
PHST- 2003/10/03 05:00 [pubmed]
PHST- 2004/01/15 05:00 [medline]
PHST- 2003/10/03 05:00 [entrez]
AID - 10.1093/ajhp/60.18.1841 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2003 Sep 15;60(18):1841-9. doi: 10.1093/ajhp/60.18.1841.