The 12-month results of HORIZONS-AMI (Oct 3, p 1149) show that, in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), anti-coagulation with bivalirudin reduced net adverse clinical events and major bleeding at 1 year compared with heparin plus a glycoprotein llb/llla inhibitor. The difference, evident almost immediately after the procedure, was due to reduced bleeding with bivalirudin. Very early, but not 12-month, stent thrombosis was increased in the bivalirudin group. Of interest, major adverse cardiac events were lower in those given a 600 mg clopidogrel loading dose than in those given 300 mg, irrespective of antithrombin treatment.
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