American Society of Hirudotherapy

Bivalirudin in acute coronary syndromes

Narrative review published in Expert review of cardiovascular therapy (2023)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportClinical LiteratureDrug DevelopmentSafety & Infection ControlSalivary PharmacologyGalli M et al. · Expert review of cardiovascular therapy, 2023

Abstract

INTRODUCTION: Bivalirudin, a bivalent direct thrombin inhibitor, has been developed to reduce bleeding without any trade-off in thrombotic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). AREAS COVERED: Despite showing a superior safety profile compared with unfractionated heparin (UFH), bivalirudin is not considered the anticoagulant of choice in ACS patients undergoing PCI, mainly because of an increased rate of acute stent thrombosis (ST) shown by several randomized controlled trials (RCTs), in addition to limited availability in certain countries and increased costs. However, RCTs on bivalirudin have been characterized by several confounding factors hindering the interpretation of its safety and efficacy compared with UFH among the spectrum of ACS patients. Furthermore, a significant body of evidence has demonstrated that the risk of acute ST can be mitigated by a full-dose infusion regimen following PCI, without compromising the favorable safety profile compared to UFH. EXPERT OPINION: In light of the increased understanding of the prognostic relevance of bleeding events and the excellent safety profile of bivalirudin, recent trial evidence may allow for this anticoagulant agent to reemerge and have a more prominent role in the management of ACS patients undergoing PCI.

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

Publication typeJournal Article
Indexed MeSH termsHumansAcute Coronary SyndromeTreatment OutcomeHirudinsHeparinAntithrombinsAnticoagulantsPeptide FragmentsHemorrhagePercutaneous Coronary InterventionRecombinant Proteins

Summary

This review notes bivalirudin offers a superior bleeding profile versus unfractionated heparin in ACS patients undergoing PCI but historically increased acute stent thrombosis; full-dose post-PCI infusion may mitigate that risk without compromising safety.

Why This Matters for Hirudotherapy

This article reviews the role of bivalirudin, a bivalent direct thrombin inhibitor, in acute coronary syndrome patients undergoing percutaneous coronary intervention, discussing its safety profile relative to unfractionated heparin, the issue of acute stent thrombosis, and how infusion regimens may mitigate that risk. It suggests bivalirudin may reemerge as a relevant anticoagulant in ACS management. Bivalirudin (formerly Hirulog) is a synthetic peptide anticoagulant designed partly on the C-terminal sequence of hirudin, the anticoagulant of the medicinal leech (Maraganore et al., 1990); this paper studies the drug, not leech therapy.

Citation

Reference (Vancouver style)

Galli M, Bernardi M, Ortega-Paz L, Nerla R, D'Amario D, Franchi F, et al. Bivalirudin in acute coronary syndromes. Expert Rev Cardiovasc Ther. 2023;21(12):901-911. doi:10.1080/14779072.2023.2273902. PMID: 37919937

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.