Definition A study which asked if bivalirudin (Angiomax) was better than heparin alone and heparin plus tirofiban in patients with acute MI undergoing coronary intervention.

Conclusion Yes.

Per Han et al, at 30 days, the incidence of net adverse clinical events–NACE was lower with bivalirudin (8.8%) than with heparin alone (13.2%) or heparin plus tirofiban (17%; P<.001).

Other trials—HORIZONS-AMI and EUROMAX agreed that bivalirudin was better than heparin plus a glycoprotein IIb/IIIa inhibitor in decreasing NACE, but at a cost of increased stent thrombosis with bivalirudin. Moreover, HEAT-PPCI, showed heparin monotherapy was superior to bivalirudin alone. 



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