PMID- 26681442
OWN - NLM
STAT- MEDLINE
DCOM- 20160823
LR  - 20181202
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 50
IP  - 2
DP  - 2016 Feb
TI  - Heparin Versus Bivalirudin Monotherapy in the Setting of Primary Percutaneous 
      Coronary Intervention for Patients With ST-Segment Elevation Myocardial 
      Infarction.
PG  - 141-51
LID - 10.1177/1060028015618206 [doi]
AB  - OBJECTIVE: To evaluate direct comparisons of bivalirudin versus unfractionated 
      heparin (UFH) as anticoagulants during ST-segment elevation myocardial infarction 
      (STEMI) in patients undergoing primary percutaneous coronary intervention (PPCI). 
      DATA SOURCES: Relevant information was identified through a search of MEDLINE 
      (1966-September 2015), International Pharmaceutical Abstracts (1960-September 
      2015), and Cochrane Databases (publications archived until September 2015) using 
      the terms bivalirudin, unfractionated heparin, ST-segment elevation myocardial 
      infarction, and primary percutaneous coronary intervention. STUDY SELECTION AND 
      DATA EXTRACTION: English-language randomized controlled trials and meta-analyses 
      were eligible for inclusion for data review of STEMI where PPCI was performed. 
      DATA SYNTHESIS: Either bivalirudin or UFH is recommended in the setting of STEMI 
      where PPCI is to be performed. Bivalirudin is touted for its predictable 
      pharmacokinetics, effects on thrombin-mediated platelet inhibition, and favorable 
      outcomes with regard to adverse bleeding profiles, whereas UFH, the gold standard 
      anticoagulant during PPCI, remains a viable treatment strategy. Only recently 
      have direct comparisons of UFH and bivalirudin during PPCI become available. The 
      evidence available is complicated by variances in use of glycoprotein IIb/IIIa 
      inhibitors (GPIs), P2Y12 inhibitors, access sites, and anticoagulant dosing 
      strategies. We provide a review of contemporary trials and advancements in this 
      area. CONCLUSIONS: When compared to UFH with limited use of GPI, available 
      evidence demonstrates that bivalirudin reduces bleeding at the expense of 
      increasing risk for acute stent thrombosis. Further randomized studies are needed 
      to determine the potential benefits of a post-PCI infusion of bivalirudin to 
      reduce the risk for acute stent thrombosis, long-term follow-up beyond 30 days, 
      and mortality.
CI  - (c) The Author(s) 2015.
FAU - Faulkenberg, Kathleen D
AU  - Faulkenberg KD
AD  - Cleveland Clinic, Cleveland, OH, USA faulkek@ccf.org.
FAU - Beavers, Janna C
AU  - Beavers JC
AD  - WakeMed Health and Hospitals, Raleigh, NC, USA.
FAU - Finks, Shannon W
AU  - Finks SW
AD  - University of Tennessee College of Pharmacy, Memphis, TN, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
DEP - 20151217
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Antithrombins/therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Myocardial Infarction/therapy
MH  - Peptide Fragments/*therapeutic use
MH  - *Percutaneous Coronary Intervention
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Recombinant Proteins/therapeutic use
OTO - NOTNLM
OT  - ST-segment myocardial infarction
OT  - bivalirudin
OT  - heparin
OT  - primary percutaneous coronary intervention
EDAT- 2015/12/19 06:00
MHDA- 2016/08/24 06:00
CRDT- 2015/12/19 06:00
PHST- 2015/12/19 06:00 [entrez]
PHST- 2015/12/19 06:00 [pubmed]
PHST- 2016/08/24 06:00 [medline]
AID - 1060028015618206 [pii]
AID - 10.1177/1060028015618206 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2016 Feb;50(2):141-51. doi: 10.1177/1060028015618206. Epub 2015 
      Dec 17.