Hirulog - Bivalirudin

Bittl JA, Strony J, Brinker JA, et al. Treatment with bivalirudin (hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. N Engl J Med 1995 333 764-769. 

The Hirulog Early Reperfusion or Occlusion (HERO) trial was conducted in patients with AMI to investigate the effects of bivalirudin in combination with SKand aspirin (Table 5) (66). Four hundred and twelve patients who presented with onset of ST elevation within 12 hours were randomized in a double-blind manner to one of three adjunctive anticoagulation regimens, UFH, low-dose or high-dose bivalirudin. The... 

The Hirulog and Early Reperfusion or Occlusion (HERO) -2 Trial Investigators. Thrombin-specific anticoagulation with bivalirudin versus heparin in patients receiving fibrinolytic therapy for acute myocardial infarction the HERO-2 randomised trial. Lancet 2001 3 58 1 855-1 863,... 

The active substance in bivalirudin (Hirulog), a direct thrombin inhibitor, is a 20-amino acids ynthetic peptide based on the hirudin template. In the Hirulog angioplasty study, 4098 patients with unstable or post infarction angina were randomized to bivalirudin or heparin before PTCA (14). The conclusion of this study was that there was no difference in the 30-day primary endpoint with either treatment. Patients randomized to Hirulog, however, did have a statistically significant reduced incidence of bleeding-related complications. 

A 20 amino acid polypeptide [1], bivalirudin (hirulog) is a synthetic version of hirudin. Its amino-terminal D-Phe-Pro-Arg-Pro domain, which interacts with the active site of thrombin, is linked via four Gly residues to a dodecapeptide analogue of the carboxy-terminal of hirudin. Like hirudin, bivalirudin also forms a 1 1 stoichiometric complex with thrombin. Once bound, however, the Arg-Pro bond at the amino-terminal of bivalirudin is cleaved by thrombin, thereby restoring active site functions of the enzyme complexes of a-thrombin [2]. 

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