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Bivalirudin

In Patients with ST-Segment Elevation Myocardial Infarction

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Abstract

Bivalirudin is a synthetic 20 amino acid polypeptide that directly inhibits both fibrin-bound and soluble thrombin.

In the randomized, open-label, multicentre HORIZONS-AMI trial in patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention (PCI), compared with unfractionated heparin (UFH) plus a glycoprotein (GP) IIb/IIIa inhibitor, bivalirudin was associated with a significantly lower 30-day rate of net adverse clinical events that was largely due to the significantly lower 30-day rate of non-coronary-artery bypass grafting major bleeding. There was no significant between-group difference in the 30-day rate of major adverse cardiovascular events. These 30-day clinical outcomes were maintained at the 1- and 2-year follow-up.

Bivalirudin, compared with UFH plus a GP IIb/IIIa inhibitor, was associated with lower short- (30-day) and long- (1- and 2-year) term overall and cardiac mortality rates.

Although there was an increased risk of acute stent thrombosis within 24 hours in recipients of bivalirudin compared with UFH plus a GP IIb/IIIa inhibitor, there was no significant between-group difference between 24 hours and 30 days, ≤30 days, ≤1 year or ≤2 years.

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Acknowledgements and Disclosures

The manuscript was reviewed by: G. De Luca Division of Cardiology, Eastern Piedmont University, Novara, Italy; C.P. Juergens Department of Cardiology, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia.

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent was offered an opportunity to comment on this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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    Monique P. Curran

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Correspondence to Monique P. Curran.

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Curran, M.P. Bivalirudin. Drugs 70, 909–918 (2010). https://doi.org/10.2165/11205120-000000000-00000

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