bivalirudin (Angiomax)
Jump to navigation
Jump to search
Introduction
Tradename: Angiomax.
Indications
- prevention of thrombosis
- anticoagulant for patients undergoing angioplasty, percutaneous coronary intervention (PCI)
- acute coronary syndrome[2], NSTEMI[3]
- for use after administration of aspirin plus clopidogrel
- heparin-induced thrombocytopenia[6]
Contraindications
- during emergency medical transport for PCI[5]
Pharmacokinetics
- 1/2 life of 25 minutes
Adverse effects
- activated prothrombin concentrate complex 50-100 units/kg IV
- hemofiltration through a polyfulfone membrane[4]
Mechanism of action
- direct inhibitor of thrombin
Clinical trials
- ISAR-REACT 4 Trial
- bivalirudin alone vs heparin plus abciximab (glycoprotein IIb/IIIa inhibitor) after aspirin plus clopidogrel (600 mg) in patients undergoing PCI for NSTEMI
- bivalirudin group associated with less bleeding (2.6% vs 4.6%)
- mortality, MI & urgent revascularization similar[3]
More general terms
References
- ↑ Prescriber's Letter 8(2):11 2001
- ↑ 2.0 2.1 Stone GW et al, for the ACUITY Investigators Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006, 355:2203 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17124018
Bittl JA Accounting for Acuity N Engl J Med 2006, 355:2249 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17124024 - ↑ 3.0 3.1 3.2 Kastrati A et al. for the ISAR-REACT 4 Trial Investigators. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N Engl J Med 2011 Nov 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22077909 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1109596
- ↑ 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
- ↑ 5.0 5.1 Steg PG et al for the EUROMAX Investigators Bivalirudin Started during Emergency Transport for Primary PCI. N Engl J Med. October 30, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24171490 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1311096
Mehta SR Balancing Thrombotic Events and Bleeding in Primary PCI. N Engl J Med. October 30, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24171491 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1312702 - ↑ 6.0 6.1 Deprecated Reference