Risk guided use of the direct thrombin inhibitor bivalirudin: insights from recent trials and analyses

Hillegass, William B.; Bradford, Gregory S.

doi:10.21037/jtd.2016.08.79

Cited by 3 publications

(2 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 These high-risk patients would likely include STEMI presentation, predicted major bleeding risk >2% by CathPCI Registry Bleeding Risk Calculator, and heart failure/LVEF <35% patients. 4 Heart failure and low EF patients undergoing PCI have been retrospectively observed to have substantially better outcomes with bivalirudin versus heparin including mortality (3.3 vs. 7.5% at 30-days and 9.4 vs. 15.0% at 1-year, N = 937, p = .007). 5 With one of the most peculiar and remarkable biopharmaceutical industry life-cycles, bivalirudin may remain a useful niche agent in select high-risk patients in the radial PCI era.…”

mentioning

confidence: 99%

“…Further, a risk‐guided bivalirudin approach, akin to the derivation and use of the dual antiplatelet therapy (DAPT) score, may cost‐effectively improve outcomes in select high‐risk patients undergoing PCI from the radial approach, particularly given the lower generic bivalirudin cost 3 . These high‐risk patients would likely include STEMI presentation, predicted major bleeding risk >2% by CathPCI Registry Bleeding Risk Calculator, and heart failure/LVEF <35% patients 4 . Heart failure and low EF patients undergoing PCI have been retrospectively observed to have substantially better outcomes with bivalirudin versus heparin including mortality (3.3 vs. 7.5% at 30‐days and 9.4 vs. 15.0% at 1‐year, N = 937, p = .007) 5 .…”

mentioning

confidence: 99%

See 1 more Smart Citation

Radial access and risk guided use of bivalirudin?

Ashley

Hillegass

2020

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Key Points In radial access percutaneous coronary intervention (PCI) for acute coronary syndromes, study‐level meta‐analysis suggests no long‐term benefit of bivalirudin over heparin. Individual patient data meta‐analysis, however, suggests 28% lower cardiac mortality, 43% fewer serious bleeds, and 39% less non‐access site serious bleeds in ST‐elevation myocardial infarction (STEMI) patients with bivalirudin versus heparin adjusting for access site. Higher stent thrombosis risk with bivalirudin appears neutralized with post‐procedural infusion. Risk‐guided bivalirudin use with radial access in high‐risk PCI patients with STEMI, increased bleeding risk (>2%), and/or clinical heart failure/left ventricular ejection fraction (LVEF) <35% might improve outcomes and cost, warranting further study.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Radial access and risk guided use of bivalirudin?

Ashley

Hillegass

2020

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

show abstract

Neurological complications of cardiovascular drugs

Kelly

2021

Handbook of Clinical Neurology

View full text Add to dashboard Cite

Efficacy and safety of next-generation tick transcriptome-derived direct thrombin inhibitors

et al. 2021

View full text Add to dashboard Cite

Despite their limitations, unfractionated heparin (UFH) and bivalirudin remain standard-of-care parenteral anticoagulants for percutaneous coronary intervention (PCI). We discovered novel direct thrombin inhibitors (DTIs) from tick salivary transcriptomes and optimised their pharmacologic activity. The most potent, ultravariegin, inhibits thrombin with a Ki of 4.0 pM, 445-fold better than bivalirudin. Unexpectedly, despite their greater antithrombotic effect, variegin/ultravariegin demonstrated less bleeding, achieving a 3-to-7-fold wider therapeutic index in rodent thrombosis and bleeding models. When used in combination with aspirin and ticagrelor in a porcine model, variegin/ultravariegin reduced stent thrombosis compared with antiplatelet therapy alone but achieved a 5-to-7-fold lower bleeding time than UFH/bivalirudin. Moreover, two antibodies screened from a naïve human antibody library effectively reversed the anticoagulant activity of ultravariegin, demonstrating proof-of-principle for antidote reversal. Variegin and ultravariegin are promising translational candidates for next-generation DTIs that may reduce peri-PCI bleeding in the presence of antiplatelet therapy.

show abstract

Risk guided use of the direct thrombin inhibitor bivalirudin: insights from recent trials and analyses

Cited by 3 publications

References 51 publications

Radial access and risk guided use of bivalirudin?

Radial access and risk guided use of bivalirudin?

Neurological complications of cardiovascular drugs

Efficacy and safety of next-generation tick transcriptome-derived direct thrombin inhibitors

Contact Info

Product

Resources

About