A 55-year-old man with NSTEMI and a creatinine clearance of 30 mL/min is planned for an early invasive strategy. Which anticoagulant is preferred in this setting?

• A Enoxaparin at standard weight-based dosing
• B Unfractionated heparin without dose adjustment
• C Fondaparinux
• D Bivalirudin ✓

Explanation

Bivalirudin is a direct thrombin inhibitor that is preferred in patients with renal impairment undergoing PCI for NSTEMI because it does not require dose adjustment in renal dysfunction and has lower bleeding risk. Enoxaparin requires dose reduction when CrCl <30 mL/min. Fondaparinux is contraindicated when CrCl <20 mL/min. UFH requires aPTT monitoring but is also used; however bivalirudin has superior safety in this context.

Reference: Braunwald's Heart Disease, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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