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Previous evidence indicates that bivalirudin provides a moderate benefit over unfractionated heparin (UFH) in patients undergoing primary percutaneous coronary intervention (PPCI). To further compare these agents in this setting, U.K. investigators conducted a single-center, open-label, randomized, controlled trial involving 1829 consecutive patients with acute ST-elevation myocardial infarction scheduled for emergency angiography, of whom 1491 (82%) underwent subsequent PPCI (NCT01519518).
Patients were randomized to UFH (70 U/kg) or bivalirudin (bolus 0.75 mg/kg, infusion 1.75 mg/kg/hr). Additional doses were administered if activated clotting-time values 5 to 15 minutes after the bolus dose or at the end of the procedure were <200 seconds…