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THE PHARMA REVIEW (NOVEMBER - DECEMBER 2011)

Bivalirudin In Patients with Acute Coronary Syndrome

Dr. Pradnya Palekar Shanbhag, Mahesh Abhyankar, Sanket Shah, Sudarshan Kalsulkar, Gaurav Tripathi, Prafulla Belge

Abstract: Arterial thrombosis is one of the leading causes of morbidity and mortality in the world today. Heparin was discovered in the early 1900s and since then has been used the cornerstone anti-thrombin agent in cardiovascular procedures. Other anticoagulants and antithrombotic drugs have played a key role too in the prophylaxis and treatment of thrombotic and cardiovascular disorders. But, heparin use has its own set of limitations. Bivalirudin, a synthetic polypeptide and intravenous reversible direct thrombin inhibitor can be the most promising replacement of Heprin among the novel anti-coagulants.

 
Introduction Non-communicable diseases especially cardiovascular diseases (CVD) have assumed epidemic proportions in India. Coronary artery disease (CAD) is fast becoming a major cause of morbidity and mortality in the developing world. As per the National Commission on Macroeconomics and Health, Government of India, by 2015, there will be an alarming 62 million coronary heart disease patients in India alone. Acute Coronary Syndrome (ACS) includes a spectrum of clinical conditions produced by acute myocardial ischemia (MI) and comprises unstable angina (UA), ST - elevation myocardial infarction (STEMI) and non - ST elevation ACS (NSTE-ACS). Antithrombotic therapies still forms the mainstay of pharmacological management of ACS.

 
The role of thrombin inhibition in the treatment of acute coronary syndrome was well established even before percutaneous coronary intervention (PCI) became a part of its management strategy. Heparin has played a pivotal role as a standard anti-thrombin agent in PCI since the first percutaneous transluminal coronary angioplasty (PTCA) performed by Andreas Gruentzig in 1977. However, its use has following limtations:

 

 

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