Abstract
Bivalirudin is a member of the direct thrombin inhibitor drug class and has been investigated as an alternative to unfractionated heparin for the treatment of patients with acute coronary syndrome.1 The results of the HORIZONS-AMI trial2 led to the increased use of bivalirudin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), with class I recommendations in both the US and European STEMI guidelines.3,4 However, this initial enthusiasm was dampened by the results of subsequent trials, in particular because of concern over the increased risk of stent thrombosis observed in HEAT-PPCI5 and EUROMAX.
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