Key result
Bivalirudin use in acute coronary syndromes is reviewed, highlighting its pharmacological properties, clinical trial efficacy and safety data, and current guideline recommendations.
Why the study?
What is the role, efficacy, and safety of bivalirudin in the management of acute coronary syndromes according to clinical trials and guidelines?
What is the role, efficacy, and safety of bivalirudin in the management of acute coronary syndromes according to clinical trials and guidelines?
This review summarizes the pharmacological properties, clinical trial evidence, and guideline recommendations for bivalirudin in ACS, highlighting ongoing controversies in its use.
Answers are grounded in this paper and cite their sources.
Bivalirudin remains viable in ACS; challenges guideline-trial discordance and extends evidence synthesis for updated recommendations.
The pathophysiology of acute coronary syndrome (ACS) involves platelet activation and thrombus formation after the rupture of atherosclerotic plaques. Thrombin is generated at the blood-plaque interface in association with cellular membranes on cells and platelets. Thrombin also amplifies the response to the tissue injury, coagulation and platelet response, so the treatment of ACS is based on the combined use of both antiplatelet (such as aspirin, clopidogrel, prasugrel and ticagrelor) and antithrombotic drugs (unfractionated heparin, enoxaparin, fondaparinux and bivalirudin). Bivalirudin competitively inhibits thrombin with high affinity, a predictable response from its linear pharmacokinetics and short action. However, a present remarkable controversy exists between the latest main Guidelines in Clinical Practice and the key trials evaluating the use of bivalirudin in ACS. The aim of this review is to update the development of bivalirudin, including pharmacological properties, obtained information from clinical trials evaluating efficacy and safety of bivalirudin in ACS; as well as the recommendations of clinical Guidelines.
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Esteve‐Pastor et al. (2016) conducted a review in Acute Coronary Syndromes. Bivalirudin was evaluated. Bivalirudin use in acute coronary syndromes is reviewed, highlighting its pharmacological properties, clinical trial efficacy and safety data, and current guideline recommendations.
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