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Abstract:

Aim: was to study the safety and efficacy of the use of the drug bivalirudin in patients with acute coronary syndrome (ACS) with ST-segment elevation.

Materials and methods: the study included 20 patients which were admitted to hospital with a diagnosis of ACS with ST-segment elevation. Among patients - 3 women and 17 men. The age of patients ranged from 31 to 79 years, mean 56±10,8 years. Myocardial infarction of bottom wall of left ventricular (LV) was diagnosed in 9 (45%) patients, front wall - 11(55%) patients. All patients in the emergency order underwent coronary angiography (CA) with further PCI. Multivessel coronary disease was found in 35% of patients, occlusion of a coronary artery - in 20% of cases, bifurcation lesion - 15% of patients, the left main coronary artery - in 30% of cases. Before performing the PCI, 14(70%) of patients were given clopidogrel (600 mg), 6 (30%) of patients - ticagrelor (180 mg) in combination with aspirin. Intraoperative, patients received bivalirudin («Angioks») under the scheme: 0.75 mg/kg intravenous bolus, further - intravenous infusion at a rate of 1.75 mg/kg/h during the whole period of endovascular intervention.

Three patients due to technical features during the operation underwent intracoronary thrombolytic therapy In 2 cases, situation required the installation of intra-aortic balloon counterpulsation. Results: 20 patients underwent implanting of 27 stents (mean 1,35). Immediate technical success of endovascular intervention was 100%. In the intensive care unit for 4 hours after surgery lasted bivalirudin infusion at a dose of 0.25 mg/kg/h, after the transfer to the Department of Cardiology continued therapy with enoxaparin within five days. After endovascular intervention patients were converted to standard doses of clopidogrel (75 mg daily) or ticagrelor (90 mg, 2 times a day), depending on drug, that patient was given during PCI and aspirin (100 mg); and patients receive adequate medical therapy of main disease according to standards of the disease. We presented clinical experience that shows safety of bivalirudin: in the group of patients was not observed any hemorrhagic complication during the time that patients were in a hospital.

 

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