[Antithrombotic agents in clinical practice].

Abstract

The accumulation of evidence of efficacy and tolerance led to the FDA approval of bivalirudine in the United States and it has progressively replaced the use of unfractionated heparin in its traditional indication in the catheter laboratory of the Washington Hospital Center. This change has probably contributed to the reduction of bleeding complications observed in this institution. The experience acquired also showed a reduced risk of enzyme rises after the procedure. The use of bivalirudine in conditions comparable to those of the REPLACE II trial confirms that anti GPIIb/IIIa molecules should be reserved for extreme circumstances rather than be systematically associated with heparin, so significantly reducing the cost of the interventional procedures.