Does 'SWITCHing' from heparin to bivalirudin monotherapy result in a bleeding benefit?

Abstract

Bleeding is the commonest non-ischaemic complication associated with percutaneous coronary intervention (PCI), leading to a substantial increase in morbidity and mortality rates. Until recently, this was accepted as an inherent risk associated with the use of antithrombotic and antiplatelet agents in the management of acute coronary syndromes (ACS). However, recent trials have shown that the direct thrombin inhibitor bivalirudin can be used safely and effectively at the time of PCI, significantly reducing rates of bleeding with equivalent rates of ischaemic complications. This article reviews the data from recent randomized controlled trials comparing the use of unfractionated/low molecular weight heparin plus glycoprotein (GP) IIb/IIIa agents with bivalirudin and presents the evidence suggesting that making the switch from heparin to bivalirudin monotherapy at the time of PCI does indeed confer a “bleeding benefit”.