American Society of Hirudotherapy

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

Research article published in World journal of clinical cases (2025)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportSafety & Infection ControlSalivary PharmacologyClinical TrialsCheng CY et al. · World journal of clinical cases, 2025

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.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeLetter

Summary

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.

Why This Matters for Hirudotherapy

This article discusses a study of bivalirudin, a direct thrombin inhibitor, in older patients with acute coronary syndrome undergoing percutaneous coronary intervention, reporting that compared with unfractionated heparin it reduced emergency response time, improved cardiac function indicators, and lowered cardiovascular events, recurrent myocardial infarction, and bleeding complications. Its relevance to hirudotherapy is conceptual and historical: bivalirudin is a synthetic peptide modeled on hirudin, the leech-derived thrombin inhibitor, so this represents the clinical end of the lineage that begins with the medicinal-leech secretome rather than evidence for leech treatment itself. The abstract presents this as a discussion of a single study and explicitly calls for further large-scale, high-quality trials to set usage guidelines, so the findings are preliminary, pertain to a manufactured drug rather than hirudotherapy, and imply no endorsement of leech therapy for cardiac indications.

Citation

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

Cheng CY et al. · World journal of clinical cases, 2025

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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