Acute Coronary Syndrome ( A Group Of Conditions With Clinical Symptoms

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Acute coronary syndrome (ACS) refers to a group of conditions with clinical symptoms similar to acute myocardial ischemia, including pressure-like chest pain associated with nausea and sweating (1). It includes non-ST segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and unstable angina (UA). ACS patients are at increased risk of myocardial infarction and death, therefore, the moderate- to high-risk patients with ACS are treated with early cardiac catheterization followed by prompt revascularization (1, 2). In order to prevent peri-procedural thrombotic problems during the percutaneous coronary intervention (PCI) anticoagulation is required (3). Anticoagulation remains the core of…show more content…
This review will aim to integrate our current understanding of the pharmacology of bivalirudin along with the clinical trials of bivalirudin reported to date. Pharmacokinetics and Pharmacodynamics Bivalirudin is a short-acting direct anti-thrombin belonging to DTI class of compounds. DTIs are structurally related to hirudin molecule (3). Bivalirudin is a hirudin analog that is a 20 amino acid synthetic polypeptide (3). It displays linear pharmacokinetics with low oral bioavailability (13, 14). Due to the low oral bioavailability, bivalirudin is given as an intravenous infusion. There is little distribution of volume with a short half-life of 25 minutes (13-15). Bivalirudin clearance is independent of gender and dose but renal function dependent (16). The drug is cleared mainly by intracellular proteolysis and 20% of the unchanged drug is cleared renally (17). Bivalirudin pharmacokinetics and pharmacodynamics have been studied in the setting of renal impairment (16). In mild renal impairment, plasma clearance of bivalirudin was not significantly decreased when compared with normal kidney function. However, in moderate and severe renal impairment, the plasma clearance of bivalirudin reduced 21% and 24%, respectively (16). Mechanism of Action Thrombin is generated from prothrombin after initiation of the
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