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Bivalirudin (Angiomax) — a direct thrombin inhibitor derived from the leech anticoagulant hirudin — is being evaluated for use in coronary interventions because it has a relatively short half-life, which implies that the anticoagulant effect quickly dissipates once the drug is discontinued. In a previous study, patients with acute coronary syndromes undergoing early invasive management experienced similar frequencies of ischemic events whether treated with unfractionated heparin (UFH) plus a platelet inhibitor or with bivalirudin with or without a platelet inhibitor, although major bleeding was less common among those who received bivalirudin alone (ACUITY; JW Oncol Hematol Dec 11 2006). In that study, the platelet inhibitor was a glycoprot…