a Department of Cardiology , Intensive care unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord , Marseille , France.
b Mediterranean Association for Research and Studies in Cardiology (MARS Cardio) , Marseille , France.
Expert Opin Pharmacother. 2019 Feb;20(3):295-304. doi: 10.1080/14656566.2018.1551361. Epub 2018 Dec 4.
Anticoagulant therapy is critical to prevent ischemic recurrences and complications in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Unfractionated heparin (UFH), an injectable anticoagulant has several limitations: lack of predictability of its biological efficacy, platelets activation, heparin-induced thrombopenia and bleedings. Bivalirudin, a synthetic direct thrombin inhibitor has biological properties that promised better clinical outcome in ACS patients undergoing PCI.
The present review aimed to summarize two decades of randomized clinical trials that compared bivalirudin to UFH in ACS patients treated with PCI. Early trials highlighted a reduction of bleedings with bivalirudin compared to UFH in combination with glycoprotein inhibitors (GPI). Recent studies questioned this reduction given that GPI are less and less used during PCI. Further, trials raised concerns about the risk of stent thrombosis in patients treated with bivalirudin. In light of this data, bivalirudin has been downgraded in international guidelines and appears as a second line anticoagulant agent after UFH.
The highly questioned reduction of bleedings under bivalirudin and the potential risk of stent thrombosis are unwarranted. Based on clinical trials, UFH has no equivalent in terms of anticoagulation in ACS patients undergoing PCI.
抗凝治疗对于预防接受经皮冠状动脉介入治疗（PCI）的急性冠脉综合征（ACS）患者的缺血性复发和并发症至关重要。普通肝素（UFH）是一种可注射的抗凝剂，具有以下几个局限性：其生物疗效缺乏可预测性、血小板激活、肝素诱导的血小板减少症和出血。比伐卢定是一种合成的直接凝血酶抑制剂，具有生物特性，有望为接受 PCI 的 ACS 患者带来更好的临床结局。
本综述旨在总结过去二十年中比较比伐卢定和 UFH 在接受 PCI 治疗的 ACS 患者中的随机临床试验。早期试验强调与联合使用糖蛋白抑制剂（GPI）的 UFH 相比，比伐卢定可减少出血。最近的研究对这种减少提出了质疑，因为在 PCI 过程中越来越少使用 GPI。此外，试验还对接受比伐卢定治疗的患者发生支架血栓的风险表示担忧。鉴于这些数据，比伐卢定在国际指南中的地位已经降低，并且在 UFH 之后成为二线抗凝药物。
比伐卢定减少出血的效果和支架血栓形成的潜在风险备受质疑。基于临床试验，UFH 在接受 PCI 的 ACS 患者的抗凝治疗中没有可与之匹敌的药物。
