Bivalirudin and Provisional Glycoprotein IIb/IIIa Blockade Compared With Heparin and Planned Glycoprotein IIb/IIIa Blockade During Percutaneous Coronary Intervention

Abstract

NFRACTIONATED HEPARIN HAS been the standard of adjunctive antithrombin therapy during percutaneous coronary intervention (PCI) for more than 25 years. Yet heparin is subject to important intrinsic limitations, including unpredictable pharmacokinetics, inhibition by plasma proteins, and the potential to activate platelets. 1-4 Considerable reductions in periprocedural complications have been achieved with Author Affiliations and Financial Disclosures are listed at the end of this article.

Safety and Effectiveness of Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…Our findings are similar with other meta-analyses with bivalirudin vs. heparin with routine GPI use (Bittl et al, 1995; Lincoff et al, 2003; Stone et al, 2006; Steg et al, 2013). …”

Lack of early augmentation of platelet reactivity after coronary intervention in patients treated with bivalirudin

“…In addition, activation induced by ADP, convulxin and PAF tended to be less after PCI compared with that seen before the procedure. In the REPLACE-2 trial the incidence of recurrent ischemic complications was low and comparable after PCI in patients treated with either bivalirudin or unfractionated heparin plus a glycoprotein IIb-IIIa inhibitor [8]. Those results are consistent with the results obtained in the present study.…”

Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization

“…Our data are similar to the findings from the HORIZONS-AMI, EUROMAX, ACUITY, ISAR-REACT 4, and REPLACE-2 trials regarding significantly reduced bleeding hazards for bivalirudin vs. UFH + GPI [3, 7, 10, 11, 22]. As expected, we also observed lower bleeding rates when UFH monotherapy was compared to UFH + abciximab.…”