{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T20:12:55Z","timestamp":1761163975602,"version":"build-2065373602"},"reference-count":28,"publisher":"Wiley","issue":"6P2","license":[{"start":{"date-parts":[[2012,1,17]],"date-time":"2012-01-17T00:00:00Z","timestamp":1326758400000},"content-version":"vor","delay-in-days":3517,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2002,6]]},"abstract":"<jats:p>In a large phase III study of patients with unstable angina treated with percutaneous transluminal coronary angioplasty (PTCA), the thrombin\u2010specific anticoagulant bivalirudin produced relative risk reductions of 22% (p=0.039) for ischemic complications and 62% (p&lt;0.001) for bleeding complications compared with heparin. Subsequent reports have shown that between\u2010treatment differences favoring fewer complications with bivalirudin also extend to high\u2010risk patients. Early heparinization promotes heparin resistance and decreases activated clotting time achieved during PTCA. These effects are relevant to patients with postinfarction angina, which is associated with a greater likelihood of early vessel closure and procedural failure. In 1006 patients with one or both of these risk factors, bivalirudin significantly reduced combined ischemic and bleeding complications compared with heparin (8.6% vs 18%, p&lt;0.001). Treatment separations favoring bivalirudin increased with risk, suggesting decreased heparin effectiveness in patients at heightened risk. Findings in three additional risk groups\u2014women, the elderly, and patients not receiving glycoprotein IIb\/IIIa inhibitors\u2014also showed fewer complications with bivalirudin therapy. Preliminary data suggest that bivalirudin can be combined safely with glycoprotein IIb\/IIIa antagonists in percutaneous coronary intervention (PCI), including PTCA. An ongoing trial is aimed at determining the efficacy and safety of heparin with planned glycoprotein IIb\/IIIa therapy versus bivalirudin with provisional glycoprotein IIb\/IIIa therapy. The use of bivalirudin in patients with heparin\u2010induced thrombocytopenia also is being evaluated after favorable findings in early compassionate\u2010use studies. The fact that between\u2010treatment differences favoring bivalirudin were especially outstanding among the high\u2010risk patients considered in this review reinforces the impression that bivalirudin is a promising and unprecedented alternative to heparin in PCI.<\/jats:p>","DOI":"10.1592\/phco.22.10.112s.33619","type":"journal-article","created":{"date-parts":[[2004,6,1]],"date-time":"2004-06-01T07:05:12Z","timestamp":1086073512000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bivalirudin Administration During Percutaneous Coronary Intervention: Emphasis on High\u2010Risk Patients"],"prefix":"10.1002","volume":"22","author":[{"given":"Amy L.","family":"Seybert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,17]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.108.4_Supplement.258S"},{"key":"e_1_2_1_3_2","first-page":"20","article-title":"Putting heparin into perspective: its history and the evolution of its use during percutaneous coronary interventions","volume":"12","author":"Kleiman N.S.","year":"2000","journal-title":"J Invas Cardiol"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-2418-6_20"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(00)90050-4"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.87.5.1622"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199509213331204"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.119374"},{"volume-title":"Clinical practice guideline no. 10. 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