Bivalirudin for anticoagulation in elderly acute coronary syndrome: Effects on myocardial microcirculation and adverse events

Abstract

The management of acute coronary syndrome (ACS) in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes. Bivalirudin, a direct inhibitor of thrombin, serves as an alternative to traditional therapies. This drug is particularly effective in enhancing myocardial microcirculation and reducing adverse events after clinical interventions. The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS. Compared with unfractionated heparin, bivalirudin markedly reduced the emergency response time and improved cardiac function indicators. It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions. These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications, thus serving as a safe, effective anticoagulation agent for older patients with ACS. Nonetheless, further large-scale, high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes. Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care, balancing efficacy and safety. Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.

Keywords: Bivalirudin; Acute coronary syndrome; Myocardial microcirculation; Elderly patients; Anticoagulation

Core Tip: While bivalirudin is more effective than heparin at reducing bleeding events and their associated risks, it has not been conclusively demonstrated to surpass heparin in improving adverse cardiac events during percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS). However, bivalirudin has been shown to enhance myocardial microcirculation and reduce adverse cardiac events following PCI in older patients with ACS. By improving blood flow at the microvascular level and mitigating procedural risks, bivalirudin proves its potential as a superior anticoagulant. It offers a safer and more effective alternative, leading to better clinical outcomes for this high-risk patient population. Thus, bivalirudin emerges as a valuable option in the management of older patients undergoing PCI for ACS.