Published online Sep 26, 2017. doi: 10.4330/wjc.v9.i9.761
Peer-review started: May 10, 2017
First decision: June 12, 2017
Revised: July 31, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: September 26, 2017
Processing time: 142 Days and 8.2 Hours
To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.
Literature search of MEDLINE and PubMed databases from 1990 to 2017 using keywords as “bivalirubin” and “angiomax”, combined with the words “safety”, “effectiveness”, “efficiency”, “side effects”, “toxicity”, “adverse effect”, and “adverse drug reaction”.
A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.
Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.
Core tip: Bivalirudin is a direct thrombin inhibitor used in clinical practice since 1990’s. It was initially introduced as an alternative medication to heparin during percutaneous coronary intervention. Early studies showed advantages of bivalirudin over heparin. We did a systematic review of the literature since 1990 and summarized all relevant trials. The majority showed better outcomes with bivalirudin. However, some trials are difficult to compare directly as protocols and patient populations differ. Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.