American Society of Hirudotherapy

Bivalirudin in percutaneous coronary intervention

Review published in Vascular health and risk management (2006)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewDrug DevelopmentLehman SJ et al. · Vascular health and risk management, 2006

Abstract

Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS). Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP) IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use ofbivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY) trial are discussed.

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

Publication typeJournal ArticleReview
Indexed MeSH termsAcute DiseaseAngioplasty, Balloon, CoronaryAnticoagulantsHemorrhageHeparinHirudinsHumansMyocardial IschemiaPeptide FragmentsPlatelet Aggregation InhibitorsRecombinant ProteinsSecondary Prevention

Summary

Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants.

Why This Matters for Hirudotherapy

This review examines the pharmacology and clinical trial evidence for bivalirudin, which the abstract explicitly identifies as a 20 amino acid polypeptide hirudin analog displaying bivalent, reversible binding to thrombin. It evaluates bivalirudin as an alternative to heparin with glycoprotein IIb/IIIa inhibitors in percutaneous coronary intervention and acute coronary syndrome, with clinical trials showing reduced bleeding without loss of anti-thrombotic efficacy. Because the abstract directly names bivalirudin as a hirudin analog, the article has a defensible, if indirect, relevance to ASH's domain, documenting the pharmacological translation of a hirudin-related compound. However, the abstract makes no mention of leeches, leech saliva, leech discovery, or hirudotherapy itself, so the connection is limited strictly to the named 'hirudin analog' relationship rather than live leech therapy or the broader leech secretome.

Citation

Bivalirudin in percutaneous coronary intervention

Lehman SJ et al. · Vascular health and risk management, 2006

DOI

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