Non-STEMI UA: Antithrombin

Direct Thrombin Inhibitor

 

Bivalirudin: Using Movies not Words to Show the Benefits: A series of downloadable Powerpoint slide videos presented by CM Gibson.  What does binding to clot bound thrombin look like anyway?

 

What does it look like to be a "Direct" thrombin inhibitor, and why is that important?

 

What does it look like to inhibit "Clot bound thrombin", and why is it important?

 

What does it look like when heparin "gets distracted" and binds to heparin binding proteins while bivalirudin "stays focused" and binds to thrombin only?

 

Because heparin is non specific and binds to platelet factor 4, it triggers an antibody reaction that in turn is associated with HIT or heparin induced thrombocytopenia

 

What does it look like when heparin activates platelets and bivalirudin does not?

 

Why is Bivalirudin associated with less bleeding? See how it becomes inactivated when it falls off thrombin, unlike heparin which remains active

ACUITY Results

ACUITY PCI Results Presented by Dr. G Stone, TCT 2006

 

ACUITY Economic Results Presented by Dr. D. Cohen, TCT 2006

 

ACUITY Impact of Duration of Infusion < 24 hours or > 24 hours among PCI pts Presented by David Cox at TCT 2006

 

ACUITY Impact of Duration of Infusion < 24 hours or > 24 hours among PCI pts Presented by Charlie Pollack at AHA 2006

 

ACUITY Gender and Outcomes TCT 2006

 

ACUITY Angiographic Results TCT 2006

 

ACUITY Bleeding Results S. Manoukian, TCT 2006

 

ACUITY Bleeding Results S. Manoukian, AHA 2006

 

ACUITY Overall Results

 

ACUITY Timing Results

 

ACUITY Transfusion Results S. Manoukian, TCT 2006

 

ACUITY Diabetic Results F Feit, AHA 2006

 

ACUITY Elderly Results K Alexander, TCT 2006

 

ACUITY CABG / Thienopyridine Results Ebrahimi, TCT 2006

 

ACUITY Switching from Enox/UFH to Bival Results H. White, AHA 2006

 

ACUITY Medical Management Desmet, AHA 2006

 ACUITY Substudy Comparing Antithrombins Upstream: Substudy of Optimal Upstream Anthithrombin Therapy In NSTE ACS Pts Mananged In The Cardiac Cath Lab: Does It Matter Which Agent Is Started In The ED? By Charles V. Pollack, Jr., M.A., M.D.

ACUITY Substudy of Time Dependence of Antithrombin Initiation: The Time Dependence of Anti-thrombin Initiation in Patients with Non-ST-segment –elevation Acute Coronary Syndrome: Subgroup Analysis form the ACUITY Trial. By Deborah B. Diercks, MD

 

REPLACE 2 Results

Bleeding among patients with CrCl > 90 Treated with Eptifibatide vs Bivalirudin AHA 2006

Association of Bleeding and Transfusion with Mortality in the Elderly Nelson AHA 2006

Bivalirudin in STEMI: Bivalirudin is currently not labeled for use in ST elevation MI. Shown below are clinical trials data and the design of an upcoming study

BIAMI

HORIZONS Trial Design: Bival vs UFH + GPiibiiia in STEMI and DES vs BMS in STEMI

Bivalirudin in Peripheral Vascular Disease: Bivalirudin is not currently labeled for use in peripheral arterial interventions. Shown below are registry data evaluating its use.

APPROVE and Registry Data in the Periphery

Indirect Thrombin Inhibitor

STEEPLE Safety and efficacy of intravenous (IV) enoxaparin compared with intravenous unfractionated heparin (UFH) in patients undergoing nonemergent PCI

SYNERGY Safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) in high-risk patients with non-ST-segment elevation acute coronary syndromes

Anti-Xa Inhibitor

OASIS 5 Treatment with fondaparinux compared with enoxaparin among patients with non-ST elevation acute coronary syndromes

 

OASIS-6 Fondaparinux in ST elevation MI