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The direct thrombin inhibitor bivalirudin has been studied as an alternative to intravenous heparin during percutaneous coronary intervention (PCI). Its short half-life (25 min) and potential for reduced platelet activation might explain why, compared with unfractionated heparin (UFH) plus planned glycoprotein IIb/IIIa inhibition in the REPLACE-2 trial, bivalirudin plus provisional GPIIb/IIIa inhibition was associated with less bleeding and a similar rate of major adverse outcomes. REPLACE-2 subjects were mostly low- and moderate-risk patients undergoing PCI (Journal Watch Cardiology Mar 28 2003).
Now, in a multinational, open-label, randomized trial funded in part by bivalirudin’s manufacturer, 13,819 acute coronary syndrome (ACS) patients …