Pharmacology and clinical use of bivalirudin

OBJECTIVE: To review the primary literature describing the pharmacology and clinical uses of bivalirudin. DATA SOURCES: A MEDLINE search (January 1966-May 2001) was conducted that used bivalirudin, hirulog, and direct thrombin inhibitor as key words. References from retrieved articles and unpublished information acquired from the manufacturer and the Internet were also used. STUDY SELECTION: All acquired articles that discussed the pharmacology, pharmacokinetics, and clinical efficacy of bivalirudin were reviewed. DATA EXTRACTION: Articles were selected based on content regarding the pharmacology and clinical use of bivalirudin. Given the paucity of data pertaining to the clinical use of bivalirudin, most articles were used, including abstracts and communications with the manufacturer. DATA SYNTHESIS: Bivalirudin is a direct thrombin inhibitor that inactivates both unbound and fibrin-bound thrombin. Bivalirudin rapidly induces anticoagulation and has a relatively short duration of action. Bivalirudin displays linear kinetics and is primarily eliminated renally. Bivalirudin was proven effective in preventing postprocedural ischemic complications in patients with unstable or postinfarction angina who received percutaneous transluminal coronary angioplasty (PTCA). Yet, further investigations that include less critically ill patients and use the current clinical practice of administering glycoprotein IIb/IIIa antagonists and/or inserting intracoronary stents are needed to fully evaluate its efficacy. Bivalirudin has also induced early patency in patients with myocardial infarction in combination with streptokinase, but its use with newer thrombolytics needs to be studied. Bivalirudin has been used in patients with immunologically mediated, heparin-induced thrombocytopenia (HIT) without complications. Bleeding is the major adverse effect and occurs more commonly in patients with renal dysfunction. CONCLUSIONS: At present, bivalirudin is worthy of consideration in patients requiring PTCA who have HIT. Advocating the routine use of bivalirudin in patients experiencing an acute coronary syndrome or HIT is premature.

This article has been cited by other articles:

				S. Singh, J. Molnar, and R. Arora Efficacy and Safety of Bivalirudin Versus Heparins in Reduction of Cardiac Outcomes in Acute Coronary Syndrome and Percutaneous Coronary Interventions Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2007; 12(4): 283 - 291. [Abstract] [PDF]

				M. Wasowicz, A. Vegas, M. A. Borger, and S. Harwood Bivalirudin anticoagulation for cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia: [L'anticoagulation avec la bivalirudine pour la circulation extracorporelle chez un patient atteint de thrombocytopenie immunitaire a l'heparine (TIH)] Can J Anesth, December 1, 2005; 52(10): 1093 - 1098. [Abstract] [Full Text] [PDF]

				A. T. Gurbuz, W. G. Elliott, and A. A. Zia Heparin-induced thrombocytopenia in the cardiovascular patient: diagnostic and treatment guidelines Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 138 - 149. [Abstract] [Full Text] [PDF]

				S. B. Clayton, J. R. Acsell, A. J. Crumbley III, A. G. Shackelford, and W. E. Uber Cardiopulmonary Bypass With Bivalirudin in Type II Heparin-Induced Thrombocytopenia Ann. Thorac. Surg., December 1, 2004; 78(6): 2167 - 2169. [Abstract] [Full Text] [PDF]

				G. Stratmann, A. M. deSilva, E. E. Tseng, J. Hambleton, M. Balea, A. J. Romo, M. J. Mann, N. L. Achorn, W. F. Moskalik, and C. W. Hoopes Reversal of Direct Thrombin Inhibition After Cardiopulmonary Bypass in a Patient with Heparin-Induced Thrombocytopenia Anesth. Analg., June 1, 2004; 98(6): 1635 - 1639. [Abstract] [Full Text] [PDF]

				T. E. Warkentin and A. Greinacher Heparin-induced thrombocytopenia and cardiac surgery Ann. Thorac. Surg., December 1, 2003; 76(6): 2121 - 2131. [Abstract] [Full Text] [PDF]

				T. E. Warkentin and A. Greinacher Heparin-induced thrombocytopenia and cardiac surgery Ann. Thorac. Surg., August 1, 2003; 76(2): 638 - 648. [Abstract] [Full Text] [PDF]

				S. Sharma, B. Bhambi, W. Nyitray, K. Desai, D. L. Davis, G. Sharma, P. Shukla, C. File, and T. Ishimori Bivalirudin (Angiomax) Use during Intracoronary Brachytherapy May Predispose to Acute Closure Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2003; 8(1): 9 - 15. [Abstract] [PDF]

				J. C. Vasquez, A. Vichiendilokkul, S. Mahmood, and F. A. Baciewicz Jr Anticoagulation with bivalirudin during cardiopulmonary bypass in cardiac surgery Ann. Thorac. Surg., December 1, 2002; 74(6): 2177 - 2179. [Abstract] [Full Text] [PDF]