In 1994, the development of bivalirudin, a novel direct thrombin inhibitor,
was precipitously suspended by the manufacturer based on an unfavorable economic
analysis comparing bivalirudin with heparin in patients undergoing angioplasty.1- 4 However,
the convergence of several events over the last 8 years maintained interest
in this agent: a new, less expensive manufacturing process was developed;
the drug was licensed to a new sponsor in 1997; and the original angioplasty
trial was reanalyzed with its results cast in a more favorable light.5,6 Now, in this issue of THE JOURNAL,
the investigators of the Randomized Evaluation in PCI Linking Angiomax to
Reduced Clinical Events (REPLACE)–2 trial7 suggest
that clinicians should consider bivalirudin as the core anticoagulant in patients
undergoing a percutaneous coronary intervention (PCI).
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