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The anticoagulation drug bivalirudin (Angiomax) may be the better choice when it comes to patients undergoing percutaneous coronary intervention (PCI), a group of procedures to treat diseased heart arteries.

In a clinical trial, researchers looked at 3,602 patients with ST-segment elevation myocardial infarction who were going through PCI with either bivalirudin or a combination of heparin and glycoprotein IIb/IIa inhibitor. They found after 30 days, anticoagulation with bivalirudin reduced major bleeding by 40 percent compared to patients taking the heparin/glycoprotein combination. In addition, bivalirudin increased event-free survival by reducing the incidence of death, reinfarction and target-vessel revascularization for ischemia and stroke. The overall rate of adverse events for patients taking bivalirudin was 9.2 percent compared to 12.1 percent for those administered heparin plus glycoprotein IIb/IIIa inhibitors.

“The reduction in mortality with bivalirudin as compared with heparin plus glycoprotein IIb/IIIa inhibitors in the present trial may be attributable to the prevention of iatrogenic hemorrhagic complications,” study authors write. “Previous trials have documented the independent relationship between major bleeding (with or without blood transfusions) and subsequent death.”

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SOURCE: The New England Journal of Medicine, 2008;358:2218-2230

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