American Society of Hirudotherapy

Bivalirudin during percutaneous coronary intervention in acute coronary syndromes

Review published in Expert opinion on pharmacotherapy (2018)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentLaine M et al. · Expert opinion on pharmacotherapy, 2018

Abstract

INTRODUCTION: Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI. AREAS COVERED: The present review aimed to summarize two decades of randomized clinical trials that compared bivalirudin to UFH in ACS patients treated with PCI. Early trials highlighted a reduction of bleedings with bivalirudin compared to UFH in combination with glycoprotein inhibitors (GPI). Recent studies questioned this reduction given that GPI are less and less used during PCI. Further, trials raised concerns about the risk of stent thrombosis in patients treated with bivalirudin. In light of this data, bivalirudin has been downgraded in international guidelines and appears as a second line anticoagulant agent after UFH. EXPERT OPINION: The highly questioned reduction of bleedings under bivalirudin and the potential risk of stent thrombosis are unwarranted. Based on clinical trials, UFH has no equivalent in terms of anticoagulation in ACS patients undergoing PCI.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAcute Coronary SyndromeAnticoagulantsAntithrombinsHeparinHirudinsHumansPeptide FragmentsPercutaneous Coronary InterventionRandomized Controlled Trials as TopicRecombinant ProteinsTreatment Outcome

Summary

Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Why This Matters for Hirudotherapy

This review summarizes approximately two decades of randomized clinical trials comparing bivalirudin—a synthetic direct thrombin inhibitor—to unfractionated heparin in acute coronary syndrome patients undergoing percutaneous coronary intervention. The abstract indicates that early bleeding reductions with bivalirudin have been questioned as glycoprotein inhibitor use declined, that concerns about stent thrombosis emerged, and that bivalirudin has been downgraded in international guidelines to a second-line

Citation

Bivalirudin during percutaneous coronary intervention in acute coronary syndromes

Laine M et al. · Expert opinion on pharmacotherapy, 2018

DOI

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

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