Bivalirudin is a direct thrombin inhibitor that has demonstrated comparable efficacy to heparin (UFH or enoxaparin) plus a glycoprotein IIb/IIIa inhibitor in NSTE-ACS patuents including those undergiing PCI with similar rates of major bleeding
Bivalirudin was associated with a significant reduction in major bleeding compared with heparin and a GPIIP/IIIa inhibitor with similar rates of ischemic endpoints.Subsequent analysis of PCI patients from the ACUITY trial suggested that timing of clopidogret therapy was important in this context.That is bivalirudin without a GPIIb/IIIa inhibitor may actually be associated with worse outcomes than with haparin in patients who only received clopiogrel more than 30minutes after PCI or not at all as opposed to before or within 30 minutes of PC