title: What is the optimal antithrombotic strategy in primary percutaneous coronary intervention?
abstract: OBJECTIVE
  Major bleeding in the setting of acute coronary syndromes and percutaneous coronary intervention has been associated with increased short-term and long-term risk for adverse cardiac events and mortality. Recent studies on antithrombotic agents in this setting have highlighted their differential impact on ischemic and hemorrhagic complications.
  
  
  RESULTS
  To measure bleeding events consistently, an updated standardized definition has been developed by the Bleeding Academic Research Consortium (BARC) representatives. Additionally, the antithrombin agent bivalirudin has emerged as a frontrunner in the invasive management of acute coronary syndromes because of fewer bleeding complications, lower long-term mortality, and similar efficacy compared with heparin plus a glycoprotein IIb/IIIa inhibitor. The mortality benefit with bivalirudin is most likely correlated with reductions in major bleeding, including in-hospital, access-site, and nonaccess site bleeding, and despite the use of preprocedural unfractionated heparin.
  
  
  CONCLUSIONS
  The BARC definition is an improved version of prior bleeding classifications, and will likely play a significant role in comparing different anticoagulation strategies in future clinical trials and registry analyses. Bivalirudin has been shown to reduce bleeding events in a multitude of diverse clinical settings and bleeding definitions, and has become the preferred antithrombotic agent in the setting of acute coronary syndromes.
authors.affiliation: Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Sergie
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D015906:Angioplasty, Balloon, Coronary; D000991:Antithrombins / Q000009:adverse effects* / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced* / Q000209:etiology / Q000517:prevention & control; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D010641:Phenotype; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D014481:United States
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin