Use of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty.

Topol, Eric J.; Bonan, Raoul; Jewitt, D E; Sigwart, Ulrich; Kakkar, Vijay V.; Rothman, Martin T.; Bono, David de; Ferguson, James J.; Willerson, J T; Strony, John

doi:10.1161/01.cir.87.5.1622

Cited by 217 publications

(98 citation statements)

References 30 publications

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“…43 Bivalirudin was initially studied in an uncontrolled, multicentre, open-label dose-determination trial of 279 patients who were undergoing percutaneous transluminal coronary angioplasty (PTCA). 44 Data from this trial suggested that the higher bivalirudin dosage regimens of 1.8-2.2 mgÁkg -1 Áhr -1 infusions may be comparable with UFH during PTCA and that further study was warranted. 44 The…”

mentioning

confidence: 84%

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Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Bivalirudin use for anticoagulating patients undergoing cardiac surgery, particularly those with or at risk for heparin-induced thrombocytopenia, has expanded over the past several years. The purpose of this review is to provide a summary of the following: the differences between indirect and direct thrombin inhibition, unfractionated heparin's limitations (i.e., heparin-induced thrombocytopenia), bivalirudin's pharmacology, recent cardiac surgery trials comparing bivalirudin and unfractionated heparin as anticoagulants, the growing role of bivalirudin-mediated anticoagulation for various surgical procedures, and the potential of bivalirudin-mediated vascular graft patency.

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mentioning

confidence: 84%

“…44 Data from this trial suggested that the higher bivalirudin dosage regimens of 1.8-2.2 mgÁkg -1 Áhr -1 infusions may be comparable with UFH during PTCA and that further study was warranted. 44 The…”

mentioning

confidence: 84%

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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“…Two dose-ranging studies (Table 1) compared subtherapeutic bivalirudin doses (those producing an activated partial thromboplastin time less than twice the control time) with therapeutic bivalirudin doses (those producing activated partial thromboplastin times more than twice the control time). 6,7 The subtherapeutic doses produced inadequate anticoagulation, to approximate the placebo effect (no anticoagulation). Topol et al 6 used 6 dose arms, which ranged from inactive to active.…”

Section: Methodsmentioning

confidence: 99%

“…The 2 trials with bivalirudin-control arms, Topol et al 6 and TIMI 7, 7 enrolled 701 patients. At the early time point, the combined OR for death was 0.42 (95% CI 0.10 to 1.81; Pϭ0.24) in favor of therapeutic anticoagulation.…”

Section: Inactive-dose Bivalirudin-controlled Trialsmentioning

confidence: 99%

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Clinical Outcomes of Bivalirudin for Ischemic Heart Disease

et al. 1999

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Background-Current treatment strategies for percutaneous coronary revascularization and acute coronary syndromes incorporate thrombin inhibition with either unfractionated or fractionated heparin. The peptide bivalirudin (Hirulog) is a direct thrombin inhibitor whose pharmacological properties differ from those of heparin. We conducted a systematic overview (meta-analysis) to assess the effect of bivalirudin on 4 end points: death, myocardial infarction, major hemorrhage, and the composite of death or infarction. Methods and Results-Six trials (5674 patients) represent the randomized, controlled bivalirudin experience, including 4603 patients undergoing elective percutaneous coronary revascularization and 1071 patients with acute coronary syndromes. ORs for the 4 clinical end points were calculated for each trial. Four trials (4973 patients) that compared bivalirudin with heparin were combined with the use of a random-effects model. In these trials, bivalirudin was associated with a significant reduction in the composite of death or infarction (OR 0.73, 95% CI 0.57 to 0.95; Pϭ0.02) at 30 to 50 days, or 14 fewer events per 1000 patients so treated. There also was a significant reduction in major hemorrhage for the same trials (OR 0.41, 95% CI 0.32 to 0.52; PϽ0.001, or 58 fewer events per 1000 patients so treated). A similar analysis combined 2 dose-ranging trials (701 patients) that compared therapeutic (activated partial thromboplastin time more than twice the control time) with subtherapeutic bivalirudin anticoagulation (activated partial thromboplastin time less than twice the control time). Conclusions-Bivalirudin is at least as effective as heparin, with clearly superior safety. Thus, it provides an unprecedented net clinical benefit over heparin in patients with ischemic heart disease. (Circulation. 1999;100:2049-2053.)

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Pharmacologic prevention of acute ischemic complications of coronary angioplasty

Wheeldon

Cumberland

1997

Cathet. Cardiovasc. Diagn.

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Use of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty.

Cited by 217 publications

References 30 publications

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Clinical Outcomes of Bivalirudin for Ischemic Heart Disease

Pharmacologic prevention of acute ischemic complications of coronary angioplasty

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