Time to Replace Heparin Use During PCI?

Unfractionated heparin (UFH) is the standard for indirect inhibition of thrombin during percutaneous coronary intervention (PCI). Recently available direct thrombin inhibitors (DTIs) such as bivalirudin have shown some advantages over UFH in terms of dosing and bleeding complications. Now, researchers have done a large, randomized comparison.

In the REPLACE-2 trial, funded by bivalirudin's manufacturer, 6010 patients were randomized to intravenous bivalirudin (with provisional glycoprotein IIb/IIIa inhibition) or to UFH (with planned GPIIb/IIIa inhibition) during elective or urgent PCI that was unrelated to acute MI or acute coronary syndrome (ACS). For bivalirudin, dosing was a 0.75-mg/kg bolus before PCI, then a 1.75-mg/kg-hour infusion fo…