Intracoronary Bivalirudin Bolus in ST-Elevation Myocardial Infarction Patients Treated with Primary Angioplasty: Theoretical Bases, Clinical Experience, and Future Applications
Review published in American Journal of Cardiovascular Drugs (2016)
Abstract
Intracoronary thrombus is a common finding in acute coronary syndromes and often correlates with adverse prognosis and complications during percutaneous coronary interventions (PCIs). Bivalirudin, a direct thrombin inhibitor, is one of the recommended antithrombotic treatments for PCI in ST-elevation myocardial infarction (STEMI). The intracoronary administration of a bivalirudin loading dose, even if off-label, offers theoretical advantages over the standard intravenous route, providing a very high drug concentration in the infarct-related artery without increasing the total dose of the drug administered. After the description in case reports of such an approach, a larger scale experience was recently reported in a large cohort of patients with STEMI treated during primary PCI with a bivalirudin intracoronary loading dose followed by the standard intravenous maintenance infusion. As a control group, a propensity score-matched cohort of patients undergoing primary PCI treated with intravenous bivalirudin in the same institution was selected. Compared with the intravenous bolus, the intracoronary administration of bivalirudin was associated with improved ST-segment resolution, lower post-procedural peak CK-MB levels, and better Thrombolysis in Myocardial Infarction (TIMI) frame count values, without difference in bleeding rates. Thus, this new promising antithrombotic strategy, based on the intracoronary administration of a bivalirudin loading dose during primary PCI, appeared safe, improved myocardial reperfusion, and mitigated enzymatic myocardial infarct size compared with the standard intravenous protocol. Randomized trials are warranted to confirm these results and evaluate the possible long-term clinical benefits.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Intracoronary bivalirudin loading dose during primary PCI for STEMI improved ST-segment resolution, lowered post-procedural CK-MB peak, and improved TIMI frame counts vs intravenous-only administration without increasing bleeding.
Why This Matters for Hirudotherapy
This article describes the intracoronary administration of a bivalirudin loading dose during primary PCI for STEMI, reporting improved ST-segment resolution, lower post-procedural CK-MB, and better TIMI frame counts versus standard intravenous bolus in a propensity score-matched cohort. The abstract describes bivalirudin as a direct thrombin inhibitor but does not mention hirudin, leeches, leech saliva, or any leech-related origin. Findings are preliminary pending randomized confirmation. 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)
Lupi A, Schaffer A, Rognoni A, Cavallino C, Bongo AS, Cortese B, et al. Intracoronary Bivalirudin Bolus in ST-Elevation Myocardial Infarction Patients Treated with Primary Angioplasty: Theoretical Bases, Clinical Experience, and Future Applications. Am J Cardiovasc Drugs. 2016;16(6):391-397. doi:10.1007/s40256-016-0186-z. PMID: 27541144
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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