Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention

Lincoff, A. Michael; Bittl, John A.; Harrington, Robert A.; Feit, Frederick; Kleiman, Neal S.; Jackman, J. Daniel; Sarembock, Ian J.; Cohen, David J.; Spriggs, Douglas; Ebrahimi, Ramin; Keren, Gadi; Carr, Jeffrey; Cohen, Éric A.; Betriu, Amadeo; Desmet, Walter; Kereiakes, Dean J.; Rutsch, Wolfgang; Wilcox, Robert G.; Feyter, Pim J. de; Vahanian, Alec; Topol, Eric J.

doi:10.1016/s1062-1458(03)00187-9

Cited by 336 publications

(530 citation statements)

References 32 publications

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“…21 Two other recent trials used Bivalirudin in patients undergoing Reviews continued PCI and concluded that there was a statistically significant reduction in death at 1year follow-up especially in the elderly subgroup (≥75 y). 22 …”

Section: Direct Thrombin Inhibitors (Hirudin Lepirudin Bivalirudin)mentioning

confidence: 99%

Acute Coronary Syndrome in the Elderly

Shanmugasundaram

Alpert

2009

Clinical Cardiology

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The spectrum of acute coronary syndrome (ACS) including unstable angina, non–ST‐elevation myocardial infarction and ST‐elevation myocardial infarction accounts for increasing numbers of deaths among persons age ≥ 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardial medications as an early‐invasive approach among this population. Copyright © 2009 Wiley Periodicals, Inc.

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Section: Direct Thrombin Inhibitors (Hirudin Lepirudin Bivalirudin)mentioning

confidence: 99%

Acute Coronary Syndrome in the Elderly

Shanmugasundaram

Alpert

2009

Clinical Cardiology

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“…Currently, bivalirudin is manufactured by Medicines Company (Parsippany, NJ, USA) at a cost of www.nature.com/aps Zhang DM et al Acta Pharmacologica Sinica npg approximately US$325 for a 250-mg vial [4] . Extensive investigations have confirmed that bivalirudin has several therapeutic features superior to UFH and LMWHs, including more predictable pharmacokinetics (PK) and pharmacodynamics (PD) behaviour, a lower proclivity to generate an immune response, and an equivalent suppression of acute ischemic events with fewer bleeding complications [5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics and pharmacodynamics of bivalirudin in young healthy Chinese volunteers

et al. 2012

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Aim:To investigate the population pharmacokinetics (PK) and pharmacodynamics (PD) of bivalirudin, a synthetic bivalent direct thrombin inhibitor, in young healthy Chinese subjects. Methods: Thirty-six young healthy volunteers were randomly assigned into 4 groups received bivalirudin 0.5 mg/kg, 0.75 mg/kg, and 1.05 mg/kg intravenous bolus, 0.75 mg/kg intravenous bolus followed by 1.75 mg/kg intravenous infusion per hour for 4 h. Blood samples were collected to measure bivalirudin plasma concentration and activated clotting time (ACT). Population PK-PD analysis was performed using the nonlinear mixed-effects model software NONMEM. The final models were validated with bootstrap and predictioncorrected visual predictive check (pcVPC) approaches. Results: The final PK model was a two-compartment model without covariates. The typical PK population values of clearance (CL), apparent distribution volume of the central-compartment (V 1 ), inter-compartmental clearance (Q) and apparent distribution volume of the peripheral compartment (V 2 ) were 0.323 L·h -1 ·kg -1 , 0.086 L/kg, 0.0957 L·h -1 ·kg -1 , and 0.0554 L/kg, respectively. The inter-individual variabilities of these parameters were 14.8%, 24.2%, fixed to 0% and 15.6%, respectively. The final PK-PD model was a sigmoid E max model without the Hill coefficient. In this model, a covariate, red blood cell count (RBC*), had a significant effect on the EC 50 value. The typical PD population values of maximum effect (E max ), EC 50 , baseline ACT value (E 0 ) and the coefficient of RBC* on EC 50 were 318 s, 2.44 mg/L, 134 s and 1.70, respectively. The inter-individual variabilities of E max , EC 50 , and E 0 were 6.80%, 46.4%, and 4.10%, respectively. Conclusion: Population PK-PD models of bivalirudin in healthy young Chinese subjects have been developed, which may provide a reference for future use of bivalirudin in China.

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“…The recently published UK HEAT-PPCI trial showed that heparin led to a lower incidence of ischemic events and a similar incidence of bleeding compared with bivalirudin, suggesting that heparin might be a more costeffective treatment on the basis of these results and its lower cost. 37 In addition to a significant reaction to its delayed consent strategy, the trial has generated much debate in the medical community because of the difference in results compared with previous trials of bivalirudin versus heparin, [38][39][40] although interestingly, a subsequent US study 41 also yielded similar results. It is not clear whether the current debate will influence the next update to the STEMI guidelines, although it is important for all health care professionals treating cardiology patients to be aware of the potential implications with respect to clinical practice as the discussions and investigations will no doubt continue.…”

Section: In Stemi Patients Who Are Receiving Antiplatelet Agents and mentioning

confidence: 99%

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

Bobadilla

2016

Critical Care Nurse

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The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non–ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study–based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient’s clinical history and presenting characteristics.

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Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention

Cited by 336 publications

References 32 publications

Acute Coronary Syndrome in the Elderly

Acute Coronary Syndrome in the Elderly

Population pharmacokinetics and pharmacodynamics of bivalirudin in young healthy Chinese volunteers

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

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