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Elliott M. Antman, MD

JAMA. 2003;289:903-905.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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).

Why would a direct thrombin inhibitor that works only distally in the coagulation cascade possibly be effective in PCI, a procedure for which it . . . [Full Text of this Article]

Author Affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.

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