Division of Cardiovascular Medicine， Gill Heart Institute， University of Kentucky， 900 S. Limestone Street， 326 Wethington Building， Lexington， KY 40536-0200， USA. Mukherjee@uky.edu
Abstract
    BACKGROUND: Bivalirudin， a direct thrombin inhibitor， has unique attributes including predictable pharmacokinetics， a reduction in bleeding complications and avoidance of heparin induced thrombocytopenia.
    OBJECTIVE: We critically review the role of bivalirudin in the management of patients with acute coronary syndrome in light of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.
    METHODS: Data from the ACUITY trial was critically reviewed along with other contemporary data.
    RESULTS/CONCLUSION: In the ACUITY trial， bivalirudin monotherapy was associated with rates of ischemic events that were noninferior to those associated with heparin plus glycoprotein IIb/IIIa inhibition， but was associated with a significantly reduced incidence of major bleeding. Bivalirudin seems to be an attractive antithrombotic agent in patients with acute coronary syndrome undergoing early invasive management.