New anticoagulant could reduce bleeding complications
Anticoagulation practice for coronary revascularisation could be set to change with the launch of a drug that improves the outcome of patients undergoing such procedures.
Bivalirudin (Angiox) is a thrombin-specific anticoagulant licensed for
use in patients undergoing percutaneous coronary intervention (PCI).
Because of the risk of thrombus formation during or after this procedure,
anticoagulant therapy is needed and is usually provided by heparin or
heparin plus glycoprotein IIb/IIIa inhibitors.
Bivalirudin, launched in the UK this week by Nycomed, has been available
in the US since 2001 and works by binding to thrombin and preventing
the conversion of fibrinogen to fibrin, avoiding clot formation. It has
a short half-life and dose-related effect so routine activated clotting
time monitoring is not necessary.
The company says that compared with heparin, bivalirudin has been shown
to reduce ischaemic events such as myocardial infarction, death and the
need for revascularisation, and reduces the risk of major bleeding for
patients undergoing PCI. It also showed non-inferiority to heparin plus
glycoprotein IIb/IIIa inhibitors in clinical trials.
Tony Gershlick, consultant cardiologist at the Glenfield Hospital, Leicester
said: “During the last decade we have seen considerable advances
in the field of interventional cardiology with improved revascularisation
techniques. While different approaches to arterial access have reduced
bleeding complications and allowed for same day discharge, the advent
of anti-thrombins such a bivalirudin may in itself reduce the bleeding
complications associated with femoral artery access.”
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