Use of Bivalirudin for Anticoagulation in Interventional Cardiovascular Procedures

Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures; however, this is at the expense of increased risk of bleeding. The optimal anticoagulation strategy for these procedures remains unclear. Unfractionated heparin is the most commonly used anticoagulant during interventional procedures, but has several limitations, such as relatively high incidence of bleeding events, occurrence of heparin-induced thrombocytopenia, and a paradoxical thrombotic effect. Contemporary studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications, but potentially increases the risk of acute stent thrombosis. This review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.