Mikkel M. Schoos1, MD, PhD; Lars Nepper-Christensen2, MD; Kiril Aleksov Ahtarovski2, MD, PhD; Kasper Kyhl2, MD, PhD; Christoffer Göransson2, MD; Lene Holmvang1, MD, MDSc; Henning Kelbæk1, MD, MDSc; Steffen Helqvist2, DM, MDSc; Dan Eik Høfsten2, DM, PhD; Lars Køber2, MD, PhD, MDSc; Niels Vejlstrup2, MD, PhD; Jacob Lønborg2; Thomas Engstrøm2, MD, MDSc, PhD
1. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; 2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
The benefits of bivalirudin or unfractionated heparin (UFH) during primary percutaneous coronary intervention (PCI) remain controversial. Bivalirudin rather than UFH plus a routine glycoprotein IIb/IIIa receptor inhibitor (GPI) has been shown to improve overall and cardiac survival and reduce bleeding complications in patients undergoing primary PCI. Several trials comparing bivalirudin and UFH±GPI have since questioned this survival advantage and created controversy related to bivalirudin-associated improved bleeding outcome and the risk of acute stent thrombosis. Recently, the VALIDATE-SWEDEHEART bivalirudin versus heparin monotherapy in myocardial infarction during PCI trial reported no differences in myocardial infarction, major ...