Dr Jonathan Day Senior Director Global Medical The Medicines Company Bivalirudin Advancing Anticoagulation in ACS MY CONFLICTS OF INTEREST ARE The Medicines Company (Employee) ANGIOX (bivalirudin) indication Bivalirudin is indicated as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI) Bivalirudin is indicated for the treatment of adult patients with acute coronary syndromes (unstable angina/non- ST segment elevation myocardial infarction (UA/NSTEMI)) planned for urgent or early intervention. Bivalirudin should be administered with aspirin and clopidogrel Please see full Prescribing Information. Indirect inhibition by heparin requires the presence of antithrombin, the actual inhibitor. 1 Indirect versus direct thrombin inhibition ANGIOX inhibits thrombin directly with high affinity and specificity. 2 ANGIOX provides effective thrombin inhibition to prevent thrombosis and thrombin- mediated platelet effects Weitz JI et al. Thromb Res. 2002;106:V275-V284. Please see full Prescribing Information. ANGIOX, with a high affinity for thrombin, displaces thrombin from fibrin. 2 ANGIOX effectively inhibits clot- bound and circulating thrombin. 2 The heparin-antithrombin complex is not effective against clot-bound thrombin. 1 This reservoir of active thrombin continues to activate platelets and trigger further clotting. 1 ANGIOX (bivalirudin) effectively inhibits clot-bound thrombin 1. Hirsh J et al. Chest. 2001;119(1 suppl):64S-94S. 2. Weitz JI et al. Thromb Res. 2002;106:V275-V284. Please see full Prescribing Information. Return to haemostasissafety advantage ANGIOX is cleaved by thrombin, allowing thrombin to quickly recover hemostatic activity upon discontinuation of ANGIOX. 2 The natural reversibility and the short, 25-minute half-life may explain the significantly lower bleeding rates seen in clinical trials. 3 When heparin dissociates from cells/proteins, there can be an anticoagulant effect even when it is not needed. This may explain the prolonged bleeding risk after discontinuation of heparin Hirsh J et al. Chest. 2001;119(suppl 1):64S-94S. 2. ANGIOX Prescribing Information. The Medicines Company; UK Ltd Please see full Prescribing Information. Broad spectrum of experience with bivalirudin in clinical trials 27,735 patients undergoing invasive management of CAD REPLACE-2 (N=6,002) CAD Planned PCI BAT (N=4,312) UA, NQWMI Planned PTCA ACUITY (N=13,819) NSTE-ACS PCI