Bivalirudin in acute coronary syndromes.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-13 DOI:10.1080/14779072.2023.2273902
Mattia Galli, Marco Bernardi, Luis Ortega-Paz, Roberto Nerla, Domenico D'Amario, Francesco Franchi, Giuseppe Biondi-Zoccai, Dominick J Angiolillo
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引用次数: 1

Abstract

Introduction: Bivalirudin, a bivalent direct thrombin inhibitor, has been developed to reduce bleeding without any trade-off in thrombotic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Areas covered: Despite showing a superior safety profile compared with unfractionated heparin (UFH), bivalirudin is not considered the anticoagulant of choice in ACS patients undergoing PCI, mainly because of an increased rate of acute stent thrombosis (ST) shown by several randomized controlled trials (RCTs), in addition to limited availability in certain countries and increased costs. However, RCTs on bivalirudin have been characterized by several confounding factors hindering the interpretation of its safety and efficacy compared with UFH among the spectrum of ACS patients. Furthermore, a significant body of evidence has demonstrated that the risk of acute ST can be mitigated by a full-dose infusion regimen following PCI, without compromising the favorable safety profile compared to UFH.

Expert opinion: In light of the increased understanding of the prognostic relevance of bleeding events and the excellent safety profile of bivalirudin, recent trial evidence may allow for this anticoagulant agent to reemerge and have a more prominent role in the management of ACS patients undergoing PCI.

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双缬氨酸治疗急性冠状动脉综合征。
引言:双缬氨酸是一种二价直接凝血酶抑制剂,已被开发用于减少接受经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征(ACS)患者的出血,而不会对血栓事件进行任何权衡。所涵盖的领域:尽管与普通肝素(UFH)相比,比伐卢定显示出更高的安全性,但在接受PCI的ACS患者中,比伐鲁定不被认为是首选抗凝剂,主要是因为几项随机对照试验(RCT)显示急性支架血栓形成(ST)的发生率增加,此外,某些国家的可用性有限,成本增加。然而,在ACS患者中,关于比伐卢定的随机对照试验有几个混杂因素阻碍了对其与UFH相比的安全性和有效性的解释。此外,大量证据表明,PCI后的全剂量输注方案可以减轻急性ST段的风险,与UFH相比,不会损害良好的安全性。专家意见:鉴于人们越来越了解出血事件的预后相关性以及比伐卢定的良好安全性,最近的试验证据可能允许这种抗凝剂再次出现,并在接受PCI的ACS患者的管理中发挥更突出的作用。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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