Bivalirudin versus heparin monotherapy in non-ST-segment elevation myocardial infarction:

Background:The optimal anti-coagulationstrategy for patients with non- ST-elevation myocardial infarctiontreated with percutaneous coronary interventionis unclear in contemporary clinical practice of radial access and potent P2Y12-inhibitors. The aim of this study was to investigate whether bivalirudin was superior to heparin monotherapy in patients with non- ST-elevation myocardial infarctionwithout routine glycoprotein IIb/IIIa inhibitoruse.Methods:In a large pre-specified subgroup of the multicentre, prospective, randomised, registry-based, open-label clinical VALIDATE-SWEDEHEART trial we randomised patients with non- ST-elevation myocardial infarctionundergoing percutaneous coronary intervention, treated with ticagreloror prasugrel, to bivalirudin or heparin monotherapy with no planned use of glycoprotein IIb/IIIa inhibitorsduring percutaneous coronary intervention. The primary endpoint was the rate of a composite of all-cause death, myocardial infarctionor major bleeding within 180 days.Results...