PMID- 21479645
OWN - NLM
STAT- MEDLINE
DCOM- 20110928
LR  - 20161125
IS  - 1573-7241 (Electronic)
IS  - 0920-3206 (Linking)
VI  - 25
IP  - 3
DP  - 2011 Jun
TI  - Use of prolonged bivalirudin infusions following percutaneous coronary 
      intervention.
PG  - 267-76
LID - 10.1007/s10557-011-6293-9 [doi]
AB  - INTRODUCTION: Antithrombotic therapy plays an integral role in percutaneous 
      coronary intervention (PCI). Bivalirudin has been evaluated in elective 
      procedures and across the spectrum of acute coronary syndromes and is associated 
      with decreased bleeding events compared to unfractionated heparin (UFH) in 
      combination with glycoprotein IIb/IIIa inhibitors (GPI) when used for the 
      duration of PCI. The use of bivalirudin beyond the end of PCI is not as well 
      established but is being explored as an option for specific patients. DISCUSSION: 
      A small increase in stent thrombosis and ischemic events has been identified in 
      large clinical trials using bivalirudin for acute coronary syndromes (ACS). The 
      reasons for this finding are unclear, but may be related to the short duration of 
      bivalirudin or the timing and dose of antiplatelet therapies in the trials. Two 
      small, single center trials have evaluated bivalirudin continued for 4 h beyond 
      the end of PCI. These trials suggest that prolonged bivalirudin infusions result 
      in less periprocedural myocardial infarction with no increase in bleeding 
      compared to intraprocedural only bivalirudin. However, these studies were not 
      powered to identify a difference in bleeding. Efforts to decrease periprocedural 
      myocardial infarction should include the appropriate use of oral antiplatelet 
      agents. An adequate and appropriately timed loading dose of thienopyridines plays 
      a key role in decreasing complications of PCI. CONCLUSION: The strategy of 
      prolonging the bivalirudin infusion at a reduced infusion rate for 4 h after 
      completion of the PCI procedure was explored and offers promising results.
FAU - Moser, Lynette R
AU  - Moser LR
AD  - Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 
      Detroit, MI 48201, USA. lynette.moser@wayne.edu
FAU - Nemerovski, Carrie W
AU  - Nemerovski CW
FAU - Good, Kelley L
AU  - Good KL
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Cardiovasc Drugs Ther
JT  - Cardiovascular drugs and therapy
JID - 8712220
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Acute Coronary Syndrome/therapy
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Antithrombins/administration & dosage/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Hirudins/administration & dosage
MH  - Humans
MH  - Peptide Fragments/administration & dosage/*therapeutic use
MH  - Recombinant Proteins/administration & dosage/therapeutic use
MH  - Stents
MH  - Thrombosis/epidemiology/etiology
MH  - Time Factors
EDAT- 2011/04/12 06:00
MHDA- 2011/09/29 06:00
CRDT- 2011/04/12 06:00
PHST- 2011/04/12 06:00 [entrez]
PHST- 2011/04/12 06:00 [pubmed]
PHST- 2011/09/29 06:00 [medline]
AID - 10.1007/s10557-011-6293-9 [doi]
PST - ppublish
SO  - Cardiovasc Drugs Ther. 2011 Jun;25(3):267-76. doi: 10.1007/s10557-011-6293-9.