Bivalirudin

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Contents 1 Introduction 2 Indications 3 Pharmacokinetics 4 Mechanism-of-action 5 Clinical-trials 6 More General Terms 7 References

Introduction

• Tradename: Angiomax.

Indications

• anticoagulant for patients undergoing angioplasty, PCI
• acute coronary syndrome [2], NSTEMI [3]
• for use after administration of aspirin plus clopidogrel

Pharmacokinetics

• 1/2 life of 25 minutes

Mechanism-of-action

• direct inhibitor of thrombin

Clinical-trials

• ISAR-REACT 4 Trial

• bivalirudin alone vs heparin plus abciximab ( glycoprotein IIb/IIIa inhibitor) after aspirin plus clopidogrel (600 mg) in patients undergoing PCI for NSTEMI
• bivalirudin group associated with less bleeding (2.6% vs 4.6%)
• mortality, MI & urgent revascularization similar [3]

More General Terms

• enzyme inhibitor
• anticoagulant

References

1. Prescriber's Letter 8(2):11 2001
2. Stone GW et al, for the ACUITY Investigators Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006, 355:2203 PMID: [1]
   - Bittl JA Accounting for Acuity N Engl J Med 2006, 355:2249 PMID: [2]
3. Kastrati A et al. for the ISAR-REACT 4 Trial Investigators. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N Engl J Med 2011 Nov 13 <PubMed> PMID: [3] <Internet> [4]

bivalirudin (Angiomax)