© 2004 by BMJ Publishing Group & British Cardiac Society
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ISCHAEMIC HEART DISEASE
Bivalirudin is a direct thrombin inhibitor that is being investigated as a potential replacement for heparin. The results of the REPLACE-2 (randomized evaluation in PCI linking Angiomax to reduced clinical events) trial last year demonstrated that at 30 days following percutaneous coronary intervention (PCI), intraprocedural administration of bivalirudin with a glycoprotein (Gp) IIb/IIIa antagonist provided similar protection from acute ischaemic events with fewer haemorrhagic complications than the combination of heparin and Gp IIb/IIIa inhibition. Follow up data reveal comparable rates of death (1.4% of patients in the heparin group v 1.0% of patients in the bivalirudin group; p = 0.15), myocardial infarction (7.4% v 8.2%; p = 0.24) and repeat revascularisation (11.4% v 12.1%; p = 0.45) at six months. An ongoing large scale trial (acute catheterization and urgent intervention triage strategy (ACUITY)) is now testing the efficacy of bivalirudin with or without Gp IIb/IIIa blockade in high risk patients.
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