Should bivalirudin be the anticoagulant of choice for percutaneous coronary intervention?
Cheuk-Kit Wong and Harvey D White*
Correspondence *Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92 189, Auckland 1030, New Zealand
Email HarveyW@adhb.govt.nz
This article has no abstract so we have provided the first paragraph of the full text.
Unfractionated heparin has been used in PCI since the procedure's introduction. This drug has important limitations, however, including its potential to activate platelets. Bivalirudin has advantages over heparin as it inhibits clot-bound and fluid-phase thrombin, does not bind to plasma proteins and is resistant to neutralization by platelet factors. The binding of bivalirudin to thrombin is noncompetitive and reversible because, after binding, thrombin cleaves a bivalirudin Arg3–Pro4 bond, re-exposing the thrombin catalytic site. Thus, bivalirudin provides intense antithrombin action for a controlled duration, which might explain its lower bleeding risk compared with heparin.
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