doi:?10.1016/S0140-6736(07)60450-4. use of bivalirudin gives little advantage over heparin among PCI individuals. In a detailed analysis of some randomized trials and observational studies with bivalirudin in AMI patients done by myself and published almost five years ago in this journal, I rendered some reflections on the future widespread use of bivalirudin. In the setting of PCI in AMI patients, and in the absence of GP IIb/IIIa inhibitors, bivalirudin did not offer any beneficial effect in the incidence of the composite end points when compared with heparin alone. For now, in real world practice, one would probably choose a well known cheaper drug that has already passed the test of time, heparin. There may be reinforcement in the sole utilization of heparin confining GP IIb/IIIa inhibitors and other intravenous antithrombotics to bailout therapy for periprocedural PCI complications in AMI patients. Therefore, instead of being the beginning of a new era with bivalirudin, it sure is usually a welcome back to an old friend, heparin. Indeed, after more than two decades, it is always good to welcome back an old friend, unfractionated heparin, as monotherapy and favored anticoagulant regimen for contemporary PCI in AMI patients. 8.3%, P 0.001), and comparable rate of major adverse cardiovascular events at 30 days (5.4%  evaluated the safety and efficacy of bivalirudin heparin when used without GP IIb/IIIa inhibitors during primary PCI in AMI patients. They observed that this rate of major bleeding was identical in the two groups (4.1% 6.7%, P=0.09). The rate of major hematoma was identical between the two groups as well (0.5% heparin when used without GP Bopindolol malonate IIb/IIIa inhibitors exhibits similar results in terms of ischemic and bleeding complications. Open in a separate windows Fig. (1) The results of major bleeding in 2 studies with AMI patients treated with primary PCI are shown. The comparison of bivalirudin to heparin plus GP IIb/IIIa inhibitors in the HORIZONS trial  (Fig. ?1A1A), and, to heparin alone in the study of Bonello L , (Fig. ?1B1B) is depicted. When bivalirudin is usually compared with heparin, there is only a significant difference in major bleeding in AMI patients undergoing PCI only when GP IIb/IIIa inhibitors are systematically added to unfractionated heparin, but not when bivalirudin is usually compared to heparin alone without the use of GP IIb/IIIa inhibitors. Reprinted with permission from Centurin OA Actual role of platelet glycoprotein IIb/IIIa receptor inhibitors as adjuntive pharmacological therapy to primary angioplasty in acute myocardial infarction: In the light of recent randomized trials and observational studies with bivalirudin . Open in a separate windows Fig. (2) The results of major adverse cardiovascular events in 2 studies Rabbit Polyclonal to CYSLTR1 with AMI patients treated with Bopindolol malonate primary PCI are shown. The comparison of bivalirudin to heparin plus GP IIb/IIIa inhibitors in the HORIZONS trial (Fig. ?2A2A) , and, to heparin alone in the study of Bonello L  (Fig. ?2B2B) is depicted. There was no significant difference in major adverse cardiovascular events in AMI patients undergoing PCI when bivalirudin was compared with unfractionated heparin with or without the use of GP IIb/IIIa inhibitors. Reprinted with permission from Centurin OA Actual role of platelet glycoprotein IIb/IIIa receptor inhibitors as adjuntive pharmacological therapy to primary angioplasty in acute myocardial infarction: In the light of recent randomized trials and observational studies with bivalirudin . There is only one large randomized controlled trial comparing bivalirudin with unfractionated heparin alone in AMI patients undergoing primary PCI. The HEAT-PPCI trial  was an open-label, single center, randomized controlled study that enrolled 1812 patients undergoing emergency coronary angiography in the setting of Bopindolol malonate acute myocardial infarction. It was found that the use of heparin, rather Bopindolol malonate than bivalirudin, confers Bopindolol malonate significant advantage in the avoidance of major adverse events. In the HEAT-PPCI trial  bivalirudin did.