Evolving role of bivalirudin in percutaneous coronary interventions; impact of the REPLACE-2 study

Expert Opinion on Investigational Drugs
Amar M Salam

Abstract

Percutaneous coronary interventions are being used with increasing frequency nowadays for the treatment of patients with coronary heart disease. Acute thrombotic complications remain one of the major limitations of these procedures for which unfractionated heparin has been the standard foundation anticoagulant. It has, however, many limitations and disadvantages that necessitated research and development of alternative anticoagulant therapies. The direct thrombin inhibitor bivalirudin has been approved as a substitute for heparin in patients undergoing angioplasty for unstable angina based on data in higher-risk patients where bivalirudin resulted in lower rates of ischaemic and bleeding complications compared to heparin. This evidence was collected prior to the widespread use of platelet glycoprotein (GP) IIb/IIIa receptor blockers, thienopyridines and intracoronary stents, considered standard practice for such patients today. The REPLACE-2 study was carried out to establish whether, in the current era, bivalirudin used with provisional GP IIb/IIIa blockade if necessary during the procedure could provide equivalent protection from ischaemic events compared with the gold standard of heparin plus routine GP IIb/IIIa blockade. Wi...Continue Reading

References

Apr 1, 1993·The American Journal of Cardiology·C P CannonE Braunwald
Jun 28, 2002·Clinical Pharmacology and Therapeutics·Richard RobsonChristopher Frampton
Nov 20, 2002·Expert Opinion on Investigational Drugs·Amar M Salam, Jassim Al Suwaidi

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Citations

Oct 6, 2005·Bioorganic & Medicinal Chemistry Letters·Dmitri TolkatchevFeng Ni

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