Cardiovascular Drugs and Therapy

, Volume 25, Issue 3, pp 267–276

Use of Prolonged Bivalirudin Infusions Following Percutaneous Coronary Intervention

  • Lynette R. Moser
  • Carrie W. Nemerovski
  • Kelley L. Good
Article

DOI: 10.1007/s10557-011-6293-9

Cite this article as:
Moser, L.R., Nemerovski, C.W. & Good, K.L. Cardiovasc Drugs Ther (2011) 25: 267. doi:10.1007/s10557-011-6293-9

Abstract

Introduction

Antithrombotic therapy plays an integral role in percutaneous coronary intervention (PCI). Bivalirudin has been evaluated in elective procedures and across the spectrum of acute coronary syndromes and is associated with decreased bleeding events compared to unfractionated heparin (UFH) in combination with glycoprotein IIb/IIIa inhibitors (GPI) when used for the duration of PCI. The use of bivalirudin beyond the end of PCI is not as well established but is being explored as an option for specific patients.

Discussion

A small increase in stent thrombosis and ischemic events has been identified in large clinical trials using bivalirudin for acute coronary syndromes (ACS). The reasons for this finding are unclear, but may be related to the short duration of bivalirudin or the timing and dose of antiplatelet therapies in the trials. Two small, single center trials have evaluated bivalirudin continued for 4 h beyond the end of PCI. These trials suggest that prolonged bivalirudin infusions result in less periprocedural myocardial infarction with no increase in bleeding compared to intraprocedural only bivalirudin. However, these studies were not powered to identify a difference in bleeding. Efforts to decrease periprocedural myocardial infarction should include the appropriate use of oral antiplatelet agents. An adequate and appropriately timed loading dose of thienopyridines plays a key role in decreasing complications of PCI.

Conclusion

The strategy of prolonging the bivalirudin infusion at a reduced infusion rate for 4 h after completion of the PCI procedure was explored and offers promising results.

Key words

BivalirudinPercutaneous coronary interventionAntithromboticCoronary artery diseaseProlonged infusionClopidogrel

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Lynette R. Moser
    • 1
    • 2
  • Carrie W. Nemerovski
    • 1
    • 3
  • Kelley L. Good
    • 4
  1. 1.Eugene Applebaum College of Pharmacy and Health SciencesWayne State UniversityDetroitUSA
  2. 2.Harper University HospitalDetroitUSA
  3. 3.Henry Ford HospitalDetroitUSA
  4. 4.Baxter HealthcareMcGraw ParkUSA