Risk-guided use of the direct thrombin inhibitor bivalirudin.

Mortality and bleeding risks after percutaneous coronary intervention (PCI) can be predicted with bedside models. Bivalirudin reduces access and non-access bleeding by almost half compared to heparin monotherapy and heparin with IIb/IIIa use. In high (>10%) baseline one-year mortality risk PCI patients, bivalirudin reduces mortality by 4% compared to heparin with IIb/IIIa therapy. Increased acute stent thrombosis may be resolved with a 4-hr post-procedure bivalirudin infusion, eliminating bivalirudin's only major drawback except cost.