Bivalirudin: An expensive heparin?

Bleeding rates with unfractionated heparin (UH) without concomitant use of glycoprotein IIb/IIIa inhibitors as compared to bivalirudin are similar. Ischemic event rates during the index hospitalization are similar in the heparin and bivalirudin subgroups. Low does heparin (60-70 units/kg) with a target ACT of 200-250 sec may obviate the historical improved safety of bivalirudin demonstrated in certain clinical trials.