bivalirudin for the treatment of st

8/18/2019 Bivalirudin for the Treatment of ST

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BJ@I H HHH BJ@I H HHH --GH-@GH-@JH JH MM@ H@ H

@M G@ I

I@G: 27 #I@M 2011

..I/I/H230

© NICE 2011. All rights reserved.

http://nice.org.uk/guidance/ta230http://nice.org.uk/guidance/ta230


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3/30

11 II

1.1 BJ@I H KH G @@ G H

HHH I@HG KH -GH-@JH M@ H

I M IHIG M HJH.

Myocardial infarction (persistent ST-segment elevation) - bivalirudin (TA230)

© NICE 2011. All rights reserved. Page 3 of 30


4/30

22 H@M H@M

2.1 BJ@I (AL, G CM) G H IHGH 'G

HI@H I@H HHG I IHIG M

HJH (C"), @I HHG KH -GH-@JH M@

H (E") I M C"'. G H G LHG

H @ H KG J J 2009. GIM

IH HGHG (C) GHHG HH J@I GI@ GH

KH G @@.

2.2 A H H C, JM JG JH GGH KH J@I

HHH G @, K I MK H M. C JG

JHG HGG (@ @HG) @ IG H H IHIGH (H C"). JG JHG @@ HG GI G JG

(HH@ G), H @@ J H M HHGG H GH. F I@@ H@G

G HG HHG, G H C.

2.3 BJ@I G GH M >H IG. "H G J@@ J@G

H 250 K GHHIH @IH >H

IG. G J@I HHG I C" G

HJIG @IG 0.75 / M KH @@K H@M M HJIG IG H H 1.75 / M KH/I H @GH H

IH H I. IG M HI I H 4 IG H

C" H @@ . AH GGH H IG H 1.75 //

I, I G IG 0.25 //I M HI

4Q12 IG G @@@M GGM. AGGI 250 J@ G IG HH,

H IGH GH HHH KH J@I G O310.00 (BHG H@

I@M BF H 61), L@I A. CGHG M JM H GHHG

IG HH IH GIHG.




5/30

33 IHI'G GIGG IHI'G GIGG

AG@ CHH (L A) G J GIHH M H IHI

J@I JK HG GIGG M H EJ +JK I (E+; L B).

3.1 IHI'G G @ J@I H KH

G @@ GH GHHM KH @MH H

H KH G @@. I@H KG I@HG KH -

GH-@JH M@ H H M C".

Clinical effectiveness

3.2 J H @@ HJGG J@I KG GHJ, I@-, G@-@, G I@HH GHIM.

!+"-A" H@ IH 3602 HHG KH E" H

M C" GHHM J@I KH IG @IG

@MH ""/""" HG. BH HHH G J G

@@. H@ G G H @GH 3 MG @@K-I H

J@@ H HG H.

3.3 HHG H J@I HHH I ( = 1800) J 0.75 /HJIG @IG J@I @@K M 1.75 //I IG HH

KG HI IHIH IH@ H @GH H H C". A H@ GH-

I@ G 0.25 //I KG I H 4 IG H

H I; 6% (105/1749) HHG J HG. A J@

( = 1.23 J@G) J@I KG IG HH (-H IG

J@I @MH ""/""" H J@G K G H H LH

H H J KGH H HH @J@). HHG H KH

@MH ""/""" H HHH I ( = 1802) J 60 "/

G M H EI HM C@M I@G

H H HHG KH E" I M C". A

@MH ""/""" H (H HRH L) KG J

KH HG GIM IH HGHG.

3.4 G H HHG K G@ GG H HHH IG, KH G@H@M

@ HHG H KH @MH ""/""" H I.

HH KG 61 MG H HHH IG. @H@M H

75% HHG K H 90% K KH. GHIM KG




6/30

IH H 123 GHG 11 IHG; 57% HHG K @@ EI

LH@M 3% H $. H IH I@H, 19 @H H GHIM

IG HM KHK GH 28 K @GH H @@K-I.

3.5 K HK M IHG: GH > JG

JGI@ JHG > @. M IHG K H

HG > JG JGI@ JHG: H (@@-IG H@HM

H@HM), H, HH JGG@ JGI@GH

G, GH. H GHH HGG KG @G GGGG. A@MGG

K IH H HH-H-HH I@H IHG K

GH 30 MG 1 M H C".

3.6 F H M IH > JG JGI@ JHG, J@IKG H H @IG @MH ""/""" H H 30 MG 1

M. " H HHH IG I 5.5% HHG > JG

JGI@ JH H 30 MG IH 12% H 1 M. F H M

IH > @, H KG GHHGH@@M GRH

( 0.0001) HK H HHH IG H 30 MG H 1 M. AH 30 MG,

> @ I 5.1% HHG H J@I I 8.8%

HHG H @IG @MH ""/""" H (H) I

( < 0.0001). AH 1 M, > @ I 5.8% HHG HJ@I I 9.2% HHG H H I ( < 0.0001).

3.7 F H GM IHG @@-IG H@HM H@HM, H

K GHHGH@@M GRH G HK HHH KH J@I

HHH KH @IG @MH ""/""" H. AH 1 M

@@K-I, @@-IG H@HM KG 3.5% H J@I I 4.8% H

H I ( = 0.037). 1-M GI@HG H@HM K

2.1% J@I 3.8% H ( = 0.005). F H HH-H-

HH I@H, 3-M @@-IG H@HM KG GRH@M @K ( = 0.03)

J@I (5.9%) H H H (7.7%).

3.8 H HHG K L H KG G@ HK

H HHH IG, G KG H H L GH, H

G K -GRH. A G@H@M H HHG H

J@I I HH JGG@ JGI@GH H H @IG

@MH ""/""" H I (7.2% KH 5.9% H 1 M), IH

HG KG H GHHGH@@M GRH.




7/30

3.9 J@@ H M GHH HGG H 30 MG H 1 M KG H@

H J@I H @IG @MH ""/""" H IG.

!KJ, GHH HGG JHG I H J@I I

KH H RGH 24 IG C".

3.10 "JGHHG H @ HG JG JHG HK H

HHH IG, KH H HKG K JHG H J@I I

GRH@M I HG I-@H JG JHG ( < 0.0001).

RH@M K HMH JHG I H J@I I

(1.4%) H H @IG @MH ""/""" H I (3.9%;

< 0.0001).

3.11 II @MGG K GH @@-IG H@HM >@. F @@-IG H@HM, H GI@HG J@I K

JI@ GH GIIG HH K @MG, IH G K H

GHHGH@@M GRH. HH KH J@I KG GGH KH K

HG > @ H HHH KH @IG @MH ""/

""" H.

3.12 " H !+"-A" H@, @ H@ GG KG IG 5.9% (214/3597)

HHG J@@, KG @ @ GG KG IG GHHHG. " @@ H E@ @G @J@ @ GG

G LH. BIG H G@@ IG HHG I M C"

KH @ H@ GG, H IHI KG H @ H M IH

GHHGH@@M I@ H G @ H@ GG H

IHG GG. BJ@I KG GGH KH GHHGH@@M GRH

IH -GG GH () @, KH @HJ G 0.684 (95%

R HJ@ 0.507 H 0.922) KH @IG @MH

""/""" H.

Cost effectiveness

3.13 IHI GIHH @MGG HH @M

@ G @M H @MGG HH-@J@ H H

!+"-A" H@. @ G HK HG. RGH H G G-H

GHIHI HH JG H H@ IG H H GR @@K-I

(1 M H G G). H G@HG H G H @@K

H JHG H I: @JH @HG; @; > @;




8/30

G GH; M@ H; H JGI@GH; H.

H G I@ KH HK-GHH (@J/) J @ H IH

GIGIH GIJJ@ J 39-M N IG I@ M@ @H.

3.14 @ G @M H M H G @@-IG H@HM

HK H HK HHHG GJ H !+"-A" H@.

3.15 AG@IH @HJ @@ JH GG GH GI IG HG

K J H K H H !+"-A" HH-H-HH

I@H. @HJ GG HHH KH J@I KH

@IG @MH ""/""" H > @, @,

G GH, H M@ H, H JGI@GH

H K 0.643, 0.536, 1.057, 0.817, 1.124 0.710, GHJ@M. AJ@ LHM GGI H @ KG 11.26 MG. +@ GG IG

42.5% KG GGI.

3.16 CGHG J@I HHH K G H GHG H@ M,

H@ JGI@GH GH@ , HI@H HG,

H HHH-@H JG JHG @-H @@K-I.

H GHG HJH@ IG GGH HHH GHG K

G ! GHG. H IG KG G IG H!+"-A" H@. HH KH H GH LGJ @MH ""/"""

H (L) KG GGI H 70% GG K

@MH ""/""" H KG GH. GH HHH

KG G GRH KG HH H @. HHH

GH HH KH J@I KG O412 KH O573 @IG

@MH ""/""" H.

3.17 K IH@HM J@IG K IG H @ H H H H@ E"

JH: J@I 0.683 KG @ H RGH M @M 0.718 KG @

GIGIH M @. IH@HM J@IG K H JK

H @HHI. CGHG @H IHG K GIH H 3.5%.

3.18 " H G-G @MGG H J@I GHHM H H @IG

@MH ""/""" H GHHM IG H KG

HJ, KH HH@ GHG O12,843 O13,110, HH@ *AG 6.256

6.166, GHJ@M. IHI'G HGH GGHJHM @MGG

GK HH H GI@HG H @ K IGH H I HG,




9/30

@I G H @HJ GG H > @ H J@I

GHHM, @ LHM, HM @MH ""/""" H IG.

3.19 @GH GGHJHM @MGG GH H G-G 1-M @MGG

GK HH H J@I GHHM KG H (HH G, H KG GH-GJ

GK *A ) 9924 (99.2%) 10,000 "CE+ GI@HG H H O20,000

*A HG@.

3.20 H IHI GH 'LH G G' GJ@

IJI@ GGIHG (@M HRH IH L IG; 100% @

H@ GG; @H H@ GH@ GHM), H "CE+ KG

O4106 *A (KH GH O367

*AG 0.089). " @@ H GG, H J@I GHHM H.

Evidence Review Group comments

3.21 E+ H HH H G @ G J@I KH

@, IH H IG @ G H $ H. E+

G HH H IHI'G GIGG J HI IH

H @M J@@ +C.

3.22 E+ H HH H +C H H H @G G J@I

HHG I C" E". +C GH $

H HH -I@ KG IG GH HHG. H H

J@I I, HHG HH KH -I@ @K H

> JG JGI@ JHG H HG K H J

-I@ . G HH KG H G H H I.

!KJ, H KG GRH HH HK HHH I

-I@ ( = 0.1060). E+ H HH H G I@ K H

+C GI@HG KI@ SH H, J H @ -I@

GH $ H. +C @G GH $

H IG H@M @ H H @ H@ GG.

E+ HIH HH IG GG GH @ G @GG KH @ H

@ H@ GG, H RH G I @ J@I G

@@M H @K H H H +C.




10/30

3.23 J@@ H E+ G HH H @ GHIHI @M M H

IHI GGG H G H G @.

HJH H KG H. E+ H HH H @

@G H G @HJ G JHG KH J@I HHH H @@ HHG

H J@I I, @GG KH HM I M

C". !KJ, HG GGIH H @H H @IGG H @.

3.24 E+ H HH H G H H H @ HHG @@ JHG G

IHI@@M L@IGJ, @HI @HM HM H. F L@, G

HHG I@ L H @ GH I H H@

H E". E+ H HH H G IH@HM J@IG @ H H

HHH GHHG, GI HH M @H-@H I@HM @

H @ G J M G GIJJ@ HK H HHH IG.H@HM HG G @HG @@K IG K H

@I H G-G @MGG. !KJ, H E+ H HH @M HJ

@H HG GGH KH H JGI@GH KI@ J

IJI@ H H GH HJGG J@I.

3.25 E+ HR G GGIG GG GHG H @,

IH HG M GRH H H GI@HG H @.

3.26 E+ KG GHGR HH H GI@HG H IHI'G @, K

GIGH HH J@I-G HJH HG @IG

@MH ""/""" H, K IGH H GGHJHM @MGG. BJ@I

H GG GH GGHJHM @MGG GG K H KG

HJ LGJ H @IG @MH ""/"""

H, H "CE+ J@I @K O5000 *A .

3.27 E+ IH L@HM @MGG H HH H IHI'G

@ KG IGH. G @I GGHJHM @MGG H @-H

J @ H GGGG H H IHHM I @-H

IHG HHG H IG. " HG @MGG H E+ I HH H

GHIHI H IHI'G @ H IG J H

G HH J IG J@I G GGH KH J GIJJ@

H @K GH H 1 M, H K@@ @KMG H @IG @MH

""/""" H J @ H NG.

3.28 E+ JGHH H @@K HK GGIG:




11/30

H H GGI 2 J@G J@I HH GH 1.23

H H IG GI@ H H I H H @@.

3.29 E+ I HH K H GGIH J@ IG KG

1.23 J@G H 2 J@G HH, J@I H H GHHM.

3.30 E+ GHH HH JGHH H H IG GI@ H

H H H @@, H H H@M

J@I @IG @@, KH @IG @MH ""/""" H @IG

GI@. E+ @G I HH H G @ H HHH KH

@IG @MH ""/""" H @IG GI@. HK

H@G J@I @IG GI@. RGH G J@I

@IG GI@ KH @@ @IG @IG L. G H@ G

J@I @IG GI@ KH @@ @IG .

3.31 E+ H H@G H KH H IHI'G GIGG

"CE H@M G@ 182 GI@ H HHH IH

M GMG KH C", K GK HH GI@ GI@HG

H@ HH I GH O162 KH @@. CGHG

GH@GH I K GHH H G@. E+ I HH

HG GH KG @ H H @IG @MH ""/"""

H I H @, J@I (J KH @@) KI@

GH-GJ. !KJ, J @H H H @HJ H J@I @IG

@@ JGIG GI@ @IG @MH ""/""" H G

H J@@.

3.32 FI@@ H@G @@ H J H IHI'G GIGG H E+

H, K J@@ KKK...I/I/A230



http://www.nice.org.uk/guidance/ta230http://www.nice.org.uk/guidance/ta230


12/30

44 CGCGH H H H JJ

4.1 AG@ CHH JK H H J@@ H @@ GH

HJGG J@I, J G J H HI -

GH-@JH M@ H (E") M IHIG

M HJH (C") H J@I @ H RHG J@I

M @ KH H H, HG K GH H, @@ G@GHG.

"H @G H H IH H HJ IG ! GIG.

4.2 CHH G H HI H H, H J

GIHH GH M H HH LHG @@ G@GHG H

@@ GG GMHG GGH KH E". CHH HH

J@I G @M IG H $ HH H HHG @G JI HG HI IG. "H KG H HH J@I G G H IG H

L IG H G@IH G G H GH. HH

LH GHGG H H I > @, K KG HIH

H HH RH J@I. C KH HI@HG,

J@I M I @GG H H JH

HHG.

Clinical effectiveness

4.3 CHH GIGG H J H @@ HJGG

J@I H KH G @@. "H HH H GI@HG

H G@ IH @ !+"-A" H@ (H H M IH >

@, H GM IHG @@-IG H@HM

H@HM) GK GHHGH@@M GRH JHG HHH KH

J@I J HHH KH @IG @MH ""/""" H. "

HI@ H H HH @@-IG H@HM KG 1.3% 1.8% @K H

J@I I H H H I H 1 3 MG @@K-I,

GHJ@M.

4.4 CHH GIGG KH G@ IHG H HG H

!+"-A" H@ LH HHG G $ @@ H.

CHH H @@ G@GHG HH H H@ G

@HHG: H @M J@I KH @MH ""/"""

HG, H KH @; H $, @ J C" J H @




13/30


14/30

4.8 CHH L@ H GG KM H J@I I, H HG

> JG JGI@ JHG GHH HGG K @K

HHG HH KH -I@ . @@ G@GHG L@

HH H G H IGH @@@M KM H -I@ KI@

I H H > JG JGI@ JHG. M GIGH HH H

I@H K J -I@ M H HG

K H, H G HG HH M J H H H >

JG JGI@ JHG. CHH H E+ HH H

KG HH HK -I@ H > JG

JGI@ JHG IH. @@ G@GHG @G L@ HH H G

H H H $ H GH -I@ ,

H@@M HG G H I H HJGG J@I @@

H. CHH KG GHGR HH G H IG -I@ HK H H@ $ @@ H KI@ H

GRH@M @H H JI@ IHG J@I.

4.9 CHH G KH H K M GIIG HHG K

KI@ LH H RH HHH KH J@I H H

IG. "H H @@ G@GHG HH HH@@M H H

GG@ H GJ J@I HG K H H HGH G @,

IH HH @HM H G HHG KI@ H G H GMHG M H GH GII H IGG HH HHH.

CHH KG GI HH GIIG I@ G@H H GG

H HGH HH@ H RH J@I.

4.10 CHH @G G H @HHG H H@. "H H HH H

KG @M G@ H@ HH H KG -@@ G KH G G G,

IH HH H GI@HG GIGH JH J@I.

CHH @I HH H KG GIRH J H GHH HH

J@I KG @@@M HJ H @MH ""/""" H @IG

, @ H @K HG > @G H@HM.

Cost effectiveness

4.11 CHH GIGG H IHI'G @ K H

H H GH HJGG G H I H@HM G KH

J@I HHH KH HHH KH @MH ""/"""

H @IG . "H H HH H G G, HHH KH J@I




15/30

KG H HJ @GG LGJ H HHH KH @MH

""/""" H @IG . G R IGH H H

HGH @GH GGHJHM @MGG.

4.12 CHH GIGG H IGHGG H IHI'G @. FGH H

CHH GIGG H HK-GH GHIHI H @: H@ GH,

K @@ JHG I@ I, @@K M GH GH H GH

H @H. IHI GH @ K H RGH GH G

1 M, H @ K H RGH GH G 3 MG. CHH KG

GHGR HH H GI@HG H 3-M @ K GGHH KH HG

H 1-M @. , H IGH H HGG IHI@@M

L@IGJ JHG KH H RGH GH H @ GIGH HH HG KG

JG@RH. IHI L@ HH H K HG JHG K I@ J @@. CHH H

HH H E+'G I@ H @ I GG. CHH

KG GHGR KH H H M H IHI HG @ G.

4.13 CHH H GIGG M IH GGIHG IG H @,

RGH@M J@ IG , G@M, @MH ""/""" H

H H I, H@M @ H@ GG. H G H J@

IG, H H @@ G@GHG HH HHH KH J@I KI@H @ H H H C", HH IGI@@M H H J@ KI@

IG. IG 1.23 J@G H H@ KG IG @I@H GH

HHH. CHH IGH KH J@G I@ G@H

H @@ G@GHG HH H 1 J@ K , G J@

KI@ IG M LH G. GHJHM @MGG KG IH M

H E+ H H @I 2 J@G GH 1.23 J@G H @, IH

H @ H M G H GI@HG. CHH KG GHGR KH H

KM HH J@ IG KG H H H @.

4.14 CHH G H GGIHG I H @MH

""/""" H IG H IHI'G @. "H H HH L,

K G H GH GH@M @MH ""/""" H, KG GGI H IG

73% @, HR 19% HRH, K G H @GH GH@M

@MH ""/""" H, @M 8.1%. CHH H

@@ G@GHG HH HG KG @@M IG L G H

JI @MH ""/""" H M MG, G @G

G @ KH HG IG HH HM @IHH H H HRH




16/30

HR. CHH H HH 100% IG HRH H

IHI'G GGHJHM @MGG G@@ H H "CE+, KH H

"CE+ J@I G H O1764 *A . CHH H

HH 100% HRH IG KG LH GH KG GHGR HH H

IG L H @ @H H H GH

HJGG J@I.

4.15 CHH G H GGIHG I @ H@ GG GH

H @. " H G-G @MGG, @ H@ GG KG GGI 42.5%

GG, @ KH $ H. A GGHJHM @MGG H IHI

K G H IG H 100% @ H G H GI@HG, KH

J@I H H HHH H. CHH KG

GHGR HH H @ GI@HG K IGH H G GG GH.

4.16 CHH GIGG H GI@HG H GGHJHM @MGG,

K 100% HRH IG KH H GGIHG 100%

@ H@ GG I@ @H GH@ GHM HG HH KH

J@I HG HH KH @MH ""/""" HG. " HG

@MGG, K KG G M H IHI H H GH

IJI@ G J@I, H "CE+ G H O4106 *A. CHH H HH HG IJI@ GH KG @@@M

I@GH, IH H HH H "CE+ I KH HG @MGG KG GH@@ K@@

KH H @@M G H GH-HJ IG !

GIG.

4.17 CHH @I H GIGG M H H IGHGG H

IHI'G G G, K HHH KH J@I H

HHH KH @MH ""/""" H @IG (HH G, KG @GG

GH@M HJ) HH H GI@HG H @ IGH H H

JIG GGHJHM @MGG. CHH @I HH H @ G

GGH KH JM @K G IHHM HH J@I

GI@ H HHH I@HG KH E" I

C".

4.18 I@HG GGIG K G H M H H G@.




17/30

Summary of Appraisal Committee's key conclusions

A230 AG@ HH@: BJ@I H HHH -GH-

@JH M@ H

H

$$M @IGM @IG

BJ@I H KH G @@ G H

HHH I@HG KH -GH-@JH M@ H (E")

I M IHIG M HJH (C").

1.1

CIH CIH HH

C@@

HHG, @I

H J@@HM

@HHJ

HHHG

BJ@I G @M IG H $ H HHG

@G JI HG HI IG. BJ@I G G

H IG H L ( @MH ""/""" H)

IG H G@IH G G H GH.

HH LH GHGG H H I >

@, K KG HIH H HH RH

J@I. C KH HI@HG, J@I M

I @GG H H JH

HHG.

4.2

H@M H@M

G RHG

H H@M

!K JHJ G

H H@M HG

HH@ H

GRH

GIGHH@ H @H-@H

RHG?

M IH > @ H GM

IHG @@-IG H@HM H@HM GK

GHHGH@@M GRH JHG HHH KH

J@I J HHH KH @IG @MH ""/

""" H. " HI@, @@-IG H@HM KG 1.3%

1.8% @K H J@I I H H H

I H 1 3 MG @@K-I, GHJ@M.

4.3

H G H GH

H HHH

H HKM

H H?

BJ@I G IG G HI@H I@H HHG KH

E" I M C".

2.1




18/30

AJG HG J@I I GHH

HGG KH H RGH 24 IG C" H H

H I

4.7

EJ @@ HJEJ @@ HJGGGG

AJ@@HM, HI

I@HM

J

A G@ H@ (!+"-A") H J G. "H

KG -@@ H@ KH G G G. !KJ, H

CHH @I HH H KG GIRH J H

GHH HH J@I KG @@@M HJ H

@MH ""/""" H @IG .

4.10

+@J H

@ @@H H !

" H $, @ J C" J H @ GG GH H

H H@. IG H @ GG GH, KH@ GG, IG H GG GH @.

! H I GG GH @ GJ KH

J@I H H@ M HHIH $ H.

CHH H HH G@ HG -GG GH

@ I@ LH $ @@ H G H

H@.

" H H@ GIGHH@ I HHG K HH KH

-I@ IH HG G H H H

$. CHH KG GHGR HH G H IG

-I@ HK H H@ $ @@

H KI@ H GRH@M @H H JI@ IHG

J@I.

4.4

4.54.8

HHG

H M H

J

CHH GIGG H IG J@I H

KH G GI@ G G H G

@@. "H KG GHGR HH HG HHH H G

IHG H H IHGH J@I H M H H HG G@.

4.7

A H M

@@@M @JH

GIIG K

H G J

H@

HJGG?

CHH KG GI HH GIIG I@

G@H H GG H HGH HH@ H RH

J@I.

4.9




19/30

EGHH H GN

H @@

HJGG

@I GHH

GIH J

M IH > @ H GM

IHG @@-IG H@HM H@HM GK

GHHGH@@M GRH JHG HHH KH

J@I J HHH KH @IG @MH ""/

""" H. " HI@, @@-IG H@HM KG 1.3%

1.8% @K H J@I I H H H

I H 1 3 MG @@K-I, GHJ@M.

4.3

EJ GH HJEJ GH HJGGGG

AJ@@HM

HI J

IHI GIHH @MGG HH

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http://www.nice.org.uk/guidance/ta230http://www.nice.org.uk/guidance/ta230http://www.nice.org.uk/guidance/ta230http://www.nice.org.uk/guidance/ta230


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66 +@H "CE I+@H "CE I

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http://www.nice.org.uk/guidance/ipg377http://www.nice.org.uk/guidance/cg94http://www.nice.org.uk/guidance/ta182http://www.nice.org.uk/guidance/ta152http://www.nice.org.uk/guidance/cg48http://www.nice.org.uk/guidance/cg48http://www.nice.org.uk/guidance/ipg74http://www.nice.org.uk/guidance/ta73http://www.nice.org.uk/guidance/ta71http://www.nice.org.uk/http://www.nice.org.uk/guidance/ta236http://www.nice.org.uk/guidance/ta236http://www.nice.org.uk/http://www.nice.org.uk/guidance/ta71http://www.nice.org.uk/guidance/ta73http://www.nice.org.uk/guidance/ipg74http://www.nice.org.uk/guidance/cg48http://www.nice.org.uk/guidance/cg48http://www.nice.org.uk/guidance/ta152http://www.nice.org.uk/guidance/ta182http://www.nice.org.uk/guidance/cg94http://www.nice.org.uk/guidance/ipg377


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24/30

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Accreditation

http://www.nice.org.uk/http://www.nice.org.uk/

bivalirudin for the treatment of st

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