Anticoagulation for acute coronary syndromes and percutaneous coronary intervention in patients with heparin-induced thrombocytopenia

Mahaffey, Kenneth W.

doi:10.1007/s11886-001-0052-7

Cited by 11 publications

(8 citation statements)

References 48 publications

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“…Minor bleeding complications, usually at the site of a prior vascular puncture, occurred in nine patients (23%). 28,38,39 Clinical outcomes were comparable to historical data sets overall.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 74%

“…Bivalirudin has been studied prospectively for use during PCI in patients with acute or previous HIT. 28,38,39 Efficacy and safety of bivalirudin from two studies that included 39 patients who required alternative anticoagulation have been reported. 28,38 Among 39 patients whom received bivalirudin, 17 had active HIT or HITTS and 22 had a history of HIT.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

“…28,38,39 Efficacy and safety of bivalirudin from two studies that included 39 patients who required alternative anticoagulation have been reported. 28,38 Among 39 patients whom received bivalirudin, 17 had active HIT or HITTS and 22 had a history of HIT. Although the indication for anticoagulation among the patients with HIT varied, 17 patients (44%) underwent PCI.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

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Treatment of Heparin-Induced Thrombocytopenia: Is There a Role for Bivalirudin?

Seybert¹,

Coons²,

Zerumsky³

2006

Pharmacotherapy

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The recognition and management of heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) has been evolving over the past several years. Although HIT is a relatively uncommon adverse event in patients receiving heparin therapy, it bears a significant risk of thrombotic events. If patients are left untreated, 50% can develop thrombosis. Several direct thrombin inhibitors have been studied as alternative anticoagulants in patients with HIT. Lepirudin and argatroban are both approved by the United States Food and Drug Administration (FDA) for the management of HIT. Lepirudin requires dosage adjustments in patients with renal insufficiency and has potential for antibody formation. Argatroban requires dosage adjustments in patients with hepatic insufficiency. Argatroban increases the international normalized ratio when coadministered with warfarin, leading to dosage difficulties when transitioning to warfarin therapy. Bivalirudin is the most recent direct thrombin inhibitor to be introduced to the market, but it is not currently FDA approved for HIT. Controversy still exists over which direct thrombin inhibitor to use, especially in acutely ill patients and in those requiring invasive or surgical procedures. Bivalirudin has a relatively short half-life and a predictable response, which makes it attractive as an anticoagulant in patients requiring invasive or surgical procedures, those who are acutely ill, or patients with both renal and hepatic insufficiency. It offers promise as an additional direct thrombin inhibitor for use in patients with HIT, but additional studies need to be performed to further define its use.

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Section: Percutaneous Coronary Interventionmentioning

confidence: 74%

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Heparin-Induced Thrombocytopenia: Is There a Role for Bivalirudin?

Seybert¹,

Coons²,

Zerumsky³

2006

Pharmacotherapy

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“…In clinical practice thrombocytopenia (platelet count < 100 x 10 3 /mm 3 ) is more common than may be recognized. 20 Type II HIT occurs in 1-3% of patients treated with heparin, and it can be lifethreatening in some patients. 20 Although thrombocytopenia most often is associated with heparin, it has been reported with LMWH, glycoprotein IIb/IIIa inhibitors, and the thienopyridines.…”

Section: Clinical Concerns: Patients With Acute Coronary Syndromes Anmentioning

confidence: 99%

“…20 Type II HIT occurs in 1-3% of patients treated with heparin, and it can be lifethreatening in some patients. 20 Although thrombocytopenia most often is associated with heparin, it has been reported with LMWH, glycoprotein IIb/IIIa inhibitors, and the thienopyridines. 21 In contrast, bivalirudin does not cross-react with HIT antibodies.…”

Section: Clinical Concerns: Patients With Acute Coronary Syndromes Anmentioning

confidence: 99%

Clinical Pharmacology of Bivalirudin

Reed

Bell

2002

Pharmacotherapy

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Much progress has been made in understanding and treating acute coronary syndromes. For patients undergoing percutaneous transluminal coronary angioplasty, anticoagulant therapy during the procedure must strike a balance between providing sufficient anticoagulation to prevent thrombus formation and ischemic complications while averting hemorrhagic complications. Bivalirudin, a thrombin-specific anticoagulant, is the only anticoagulant that reduces both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is easy to use, provides predictable anticoagulation, inactivates both free and clot-bound thrombin, and blocks thrombin-mediated platelet activation and aggregation. Drug-drug interaction studies have found no clinically relevant interactions between bivalirudin and ticlopidine, abciximab, tirofiban, or eptifibatide. Bivalirudin is well tolerated by patients who previously received low-molecular-weight heparin (LMWH), when LMWH is discontinued 8-14 hours before bivalirudin is started. Similarly, switching from heparin to bivalirudin at the time of PCI reduces both ischemic and bleeding events.

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