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Vol. 11. Núm. A.
Vigencia de los inhibidores de la glucoproteína IIb/IIIa en el tratamiento de los síndromes coronarios agudos
Páginas 20-26 (Febrero 2011)
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Vol. 11. Núm. A.
Vigencia de los inhibidores de la glucoproteína IIb/IIIa en el tratamiento de los síndromes coronarios agudos
Páginas 20-26 (Febrero 2011)
Acceso a texto completo
¿Bivalirudina o heparina asociada a inhibidores de la glucoproteína IIb/IIIa en el síndrome coronario agudo sin elevación del ST?
Bivalirudin or Heparin Plus Glycoprotein-IIb/IIIa Inhibitors for Non-ST-Elevation Acute Coronary Syndrome?
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...
Joaquín J. Alonso
Autor para correspondencia
jalonso.hflr@salud.madrid.org

Autor para correspondencia: Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28943 Fuenlabrada, Madrid, España.
, Alejandro Curcio, Catherine Graupner, Rosa María Jiménez, Pedro Talavera
Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Madrid, España
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Resumen

La bivalirudina, análogo sintético de la hirudina que se une reversiblemente a la trombina, pertenece al grupo de anticoagulantes que son inhibidores directos de la trombina con un efecto muy predecible. El objetivo de esta revisión es responder a la pregunta: ¿cuáles son la eficacia y la seguridad del tratamiento con bivalirudina en pacientes con síndrome coronario agudo sin elevación del ST, en comparación con la combinación de heparina (no fraccionada o de bajo peso molecular) e inhibidores de la glucoproteína IIb/IIIa? Ambas estrategias han sido comparadas en dos estudios (ACUITY y REPLACE-2), de diseño e interpretación difícil, y que han mostrado una eficacia en términos de prevención de eventos cardiacos similar y disminución de las complicaciones hemorrágicas en los grupos asignados a recibir tratamiento con bivalirudina. Se realiza un análisis crítico de las evidencias y de las limitaciones existentes, que pueden servir de base para implantar una u otra estrategia en los protocolos de manejo del síndrome coronario agudo sin elevación del ST.

Palabras clave:
Síndrome coronario agudo
Angina inestable
Infarto de miocardio
Heparina
Bivalirudina
Inhibidores de la glucoproteína IIb/IIIa
Abreviaturas:
HBPM
HNF
ICP
IGP
SCA
SCASEST
Abstract

Bivalirudin is a synthetic analog of hirudin that binds reversibly to thrombin. It belongs to a group of anticoagulants that act as direct thrombin inhibitors and whose effect is highly predictable. The aim of this review was to answer the question: How does the efficacy and safety of bivalirudin in patients with non-ST-elevation acute coronary syndrome compare with that of the combination of (unfractionated or low-molecular-weight) heparin and a glycoprotein-IIb/IIIa inhibitor? The two treatment strategies have been compared in two studies (i.e. ACUITY and REPLACE-2), both of which had a complex design and were difficult to interpret. These studies demonstrated that the two treatment strategies had similar efficacy in terms of preventing cardiac events and that fewer hemorrhagic complications occurred in the groups assigned to bivalirudin. We carried out a thorough analysis of the data available and their limitations, the results of which can serve as a basis for implementing one or other strategy in treatment protocols for non-ST-elevation acute coronary syndrome.

Keywords:
Acute coronary syndrome
Unstable angina
Myocardial infarction
Heparin
Bivalirudin
Glycoprotein-IIb/IIIa inhibitors
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