PMID: 16614733Apr 15, 2006Paper

Bivalirudin: pharmacology and clinical applications

Cardiovascular Drug Reviews
Nicolas W Shammas

Abstract

Bivalirudin (Hirulog, Angiomax) is a specific, reversible and direct thrombin inhibitor with a predictable anticoagulant effect. It is cleared by both proteolytic cleavage and renal mechanisms, predominantly glomerular filtration. Bivalirudin inhibits both circulating thrombin and fibrin bound thrombin directly by binding to thrombin catalytic site and anion-binding exosite I in a concentration-dependent manner. Bivalirudin prolongs activated partial thromboplastin time, prothrombin time, thrombin time and activated clotting time (ACT). ACT levels with bivalirudin do not correlate with its clinical efficacy. Bivalirudin with a provisional GpIIb/IIIa inhibitor is indicated in elective contemporary percutaneous coronary intervention (PCI). In respect to combined ischemic and hemorrhagic endpoints of death, myocardial infarction, unplanned urgent revascularization and major bleeding during PCI (including subgroups of patients with renal impairment and diabetes) bivalirudin is not inferior to unfractioned heparin and planned GpIIb/IIIa inhibitors. In addition, bivalirudin has been consistently shown to have significantly less in-hospital major bleeding than heparin alone or heparin in combination with a GpIIb/IIIa inhibitor. Bivali...Continue Reading

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Citations

Jun 5, 2013·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Nicolas W Shammas
Oct 9, 2008·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Nicolas W ShammasMike Jerin
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Mar 5, 2010·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Nicolas W ShammasAndrew N Shammas
May 26, 2017·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Gail M AnnichMelissa M Reynolds
Mar 5, 2010·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Craig M Walker
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Apr 17, 2015·Cardiovascular Therapeutics·Ahmed MahmoudIslam Y Elgendy

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