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I had promised to report some of the information we gained attending the Society for Angiography and Interventions and American College of Cardiology annual meeting held in Chicago March 29-April 1. I was particularly struck by the number of clinical trials reporting the efficacy and safety figures for bivalirudin (Angiomax) such as ISAR-REACT 3 and HORIZONS AMI..

Bivalirudin is a direct thrombin inhibitor. It is a 20-amino acid peptide that mimics a portion of r-hirudin, a recombinant analogue of a product of medicinal leech saliva. Bivalirudin directly but reversibly binds the active protease site of thrombin to control thrombosis. Bivalirudin is indicated as an anticoagulant in patients with unstable angina undergoing percutaneous coronary intervention (PCI), particularly in patients with HIT who cannot be treated with heparin. It has only been studied in people who are taking concomitant aspirin therapy.

An IV bolus of 0.75 mg/kg is followed by an infusion of 1.75 mg/kg/h for the duration of the PCI procedure.

Bivalirudin is excreted through the kidney and must be monitored when the creatinine clearance is below 60 mL/min. It may be monitored using the PTT assay targeting 1.5 to 3 times the mean of the reference interval. During PCI it is monitored using the ACT. If the PTT is invalidated by coagulation factor deficiency or inhibitors, the ecarin (venom) clotting time may be substituted. This is offered at a number of reference laboratories Geo

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