Bivalirudin in ST-segment-elevation myocardial infarction: For better or worse?

Thomas A. Mavrakanas, Yiannis S. Chatzizisis

Research output: Contribution to journalArticlepeer-review


Bivalirudin and heparin are the major available parenteral anticoagulants for percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction. Even though hard clinical outcomes are comparable with both drugs, bivalirudin appears to be safer (less bleeding events) at the expense of lower short-term efficacy (more acute stent thrombosis events). The selection of anticoagulation during PCI in ST-segment-elevation myocardial infarction should be individualized, taking into account the patient's ischemic and bleeding risk. In patients with increased bleeding risk, bivalirudin might be preferable to heparin, whereas in complex PCI with increased risk for stent thrombosis, heparin is preferable. Further clinical studies are needed to elucidate the role of these drugs in PCI for ST-segment-elevation myocardial infarction in the era of radial approaches, new potent antiplatelet agents and the use of glycoprotein IIb/IIIa inhibitors.

Original languageEnglish (US)
Pages (from-to)893-895
Number of pages3
JournalExpert review of cardiovascular therapy
Issue number8
StatePublished - Aug 1 2015
Externally publishedYes


  • ST-segment elevation myocardial infarction
  • bivalirudin
  • bleeding
  • heparin
  • stent thrombosis

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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