Is bivalirudin just an expensive heparin?
This editorial refers to 'Bivalirudin, glycoprotein inhibitor, and heparin use, and association with outcomes of primary percutaneous coronary intervention in the United Kingdom'[1] by A. Sirker et al on page 1312. Percutaneous coronary intervention (PCI) in combination with antithrombotic drugs is the most effective therapy for acute coronary syndromes. The most frequently used injectable anticoagulants in contemporary practice are heparin and bivalirudin. Heparin was discovered by McLean and Howell 100 years ago in 1916.1 The effects of purified heparin in patients were first studied in 1935.2 For the next 80 years heparin remained the most effective and most widely used parenteral anticoagulant. Heparin has certain theoretical disadvantages: it requires antithrombin III to achieve its anticoagulation effect, it has some natural inhibitors, and it may cause a rare but serious heparin induced thrombocytopenia. The main advantage of heparin is the extensive clinical experience obtained during the last 80 years and its low price and thus wide availability. In the real life practice of interventional cardiology worldwide, unfractionated heparin (UFH) remains the cornerstone of anticoagulation treatment. To prevent bleeding complications, the heparin dosage should always be calculated individually per patient body weight: the recommended bolus is 60 100 units per kg (a lower dose for elderly patients with low body weight and for elective procedures in stable coronary artery disease; a higher dose for younger patients with acute coronary syndromes) A frequent mistake in real life practice is the use [1] #fn 2
European heart journal