February 19, 2003

Should Bivalirudin Replace Heparin During Percutaneous Coronary Interventions?

Author Affiliations

Author Affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.

JAMA. 2003;289(7):903-905. doi:10.1001/jama.289.7.903

In 1994, the development of bivalirudin, a novel direct thrombin inhibitor, was precipitously suspended by the manufacturer based on an unfavorable economic analysis comparing bivalirudin with heparin in patients undergoing angioplasty.14 However, the convergence of several events over the last 8 years maintained interest in this agent: a new, less expensive manufacturing process was developed; the drug was licensed to a new sponsor in 1997; and the original angioplasty trial was reanalyzed with its results cast in a more favorable light.5,6 Now, in this issue of THE JOURNAL, the investigators of the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)–2 trial7 suggest that clinicians should consider bivalirudin as the core anticoagulant in patients undergoing a percutaneous coronary intervention (PCI).

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