The Clinical Utility of Bivalirudin in Patients with Coronary Artery Disease

Abstract

Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

Bivalirudin Anticoagulant Therapy With or Without Platelet Glycoprotein IIb/IIIa Inhibitors During Transcatheter Coronary Interventional Procedures

“…Recently, the use of bivalirudin as a specific and reversible direct thrombin inhibitor is gradually increasing in order to overcome the limitations encountered with heparin during coronary interventional procedures. 37 Bivalirudin carries no risk of heparin-induced thrombocytopenia, does not require a binding cofactor such as antithrombin III, and does not activate platelets. 38 Pharmacologically, these characteristics make bivalirudin an ideal alternative to heparin, especially in patients with antithrombin III deficiency or relatively low platelet levels.…”

Purification of Synthetic Peptides Using a Catching Full-Length Sequence by Polymerization Approach

“…It is easy to use and readily scalable and gives peptides with good purity and recovery yields. Adapting the method for purification of several peptide drugs such as Bivalirudin (20 aa), 12 Ziconotide (25 aa), 13 Thymalfasin (28 aa), 14 Enfuvirtide (36 aa), 15 and Pramlintide (39 aa) 16 is underway.…”