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Bivalirudin, a direct thrombin inhibitor, has been studied as an alternative to heparin for patients undergoing percutaneous coronary intervention (PCI) with stable coronary artery disease,1,2 non–ST-segment elevation acute coronary syndrome (NSTE-ACS),3,4 and ST-elevation myocardial infarction (STEMI).5,6 These studies found that bivalirudin reduced major bleeding when compared with regimens of heparin plus glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors. However, many of these trials also found small numerical increases in ischemic events with bivalirudin and increases in acute stent thrombosis, particularly in patients with STEMI.5,6
Cavender MA, Faxon DP. Can BRIGHT Restore the Glow of Bivalirudin?. JAMA. 2015;313(13):1323-1324. doi:10.1001/jama.2015.2345