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 ...
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