Why the study?
Does bivalirudin monotherapy reduce major bleeding while maintaining noninferiority for ischemic events compared to heparin plus glycoprotein IIb/IIIa inhibition in patients with acute coronary syndrome undergoing early invasive management?
Does bivalirudin monotherapy reduce major bleeding while maintaining noninferiority for ischemic events compared to heparin plus glycoprotein IIb/IIIa inhibition in patients with acute coronary syndrome undergoing early invasive management?
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Bivalirudin monotherapy is an attractive antithrombotic strategy for ACS patients undergoing early invasive management due to reduced major bleeding with noninferior ischemic outcomes.
BACKGROUND: Bivalirudin, a direct thrombin inhibitor, has unique attributes including predictable pharmacokinetics, a reduction in bleeding complications and avoidance of heparin induced thrombocytopenia. OBJECTIVE: We critically review the role of bivalirudin in the management of patients with acute coronary syndrome in light of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. METHODS: Data from the ACUITY trial was critically reviewed along with other contemporary data. RESULTS/CONCLUSION: In the ACUITY trial, bivalirudin monotherapy was associated with rates of ischemic events that were noninferior to those associated with heparin plus glycoprotein IIb/IIIa inhibition, but was associated with a significantly reduced incidence of major bleeding. Bivalirudin seems to be an attractive antithrombotic agent in patients with acute coronary syndrome undergoing early invasive management.
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Mukherjee et al. (2009) studied this question.
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