Parenteral Anticoagulant Agents in PCI
Piera Capranzano
Search for more papers by this authorCorrado Tamburino
Search for more papers by this authorGeorge D. Dangas
Search for more papers by this authorPiera Capranzano
Search for more papers by this authorCorrado Tamburino
Search for more papers by this authorGeorge D. Dangas
Search for more papers by this authorGeorge D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorSummary
Unfractionated heparin has been the mainstay of anticoagulation in ischemic coronary disease for over a quarter of a century. However, pharmacologic treatment options have expanded rapidly over the past decade with the advent of low molecular weight heparins, direct thrombin inhibitors (DTI), and factor Xa inhibitors. Discrete bodies of evidence have emerged to support the use of each of these agents across the spectrum of urgent or elective percutaneous coronary intervention (PCI). This chapter examines the data on the use of available anticoagulants in the setting of PCI for the different clinical presentations of coronary artery disease (CAD), and provides summary recommendations for best clinical practice. DTI are small molecules that can bind and inactivate both circulating and clot-bound thrombin. Bivalirudin is currently the only DTI that has been extensively evaluated in several powered clinical trials with respect to its use in PCI across the broad spectrum of CAD.
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