Bivalirudin for Acute Coronary Syndromes

Patients with ACS who undergo early invasive management have similar frequencies of ischemic events with heparin plus a GpI or with bivalirudin alone, but bleeding is less common with bivalirudin.

Treatment for acute coronary syndromes (unstable angina and myocardial infarction [MI] without ST-segment elevation) consists of angiography followed by percutaneous coronary intervention, surgical intervention (coronary-artery bypass grafting), or medical management. Patients usually receive pharmacotherapy that includes aspirin, clopidogrel, a platelet glycoprotein IIb/IIIa inhibitor (GpI), and an antithrombotic agent, such as unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). Recently, an alternative antithrombotic agent — fondaparinux (Arixtra, an ultra-low-molecular-weight heparin) was evaluated. Fondaparinux is similar to the LMWH enoxaparin in reducing risk for ischemic events, but it was associated with substantiall…

Reviewing Author

David Green, MD, PhD