Bivalirudin for primary percutaneous coronary intervention in acute myocardial infarction: the HORIZONS-AMI trial

Expert Rev Cardiovasc Ther. 2012 Apr;10(4):411-22. doi: 10.1586/erc.12.24.


The combination of unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors (GPIs) has been a frequently used anti-thrombotic treatment strategy for acute coronary syndrome patients, including those with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. However, the ischemic benefit of the UFH plus GPI combination came at the expense of high rates of bleeding complications and thrombocytopenia, both of which have been independently associated with increased mortality. By contrast, bivalirudin monotherapy compared with the combination of UFH plus GPI resulted in improved net clinical outcomes, based on similar ischemic protection with significant reductions in bleeding complications in randomized trials including patients with stable angina, those with unstable angina and those with non-ST-segment elevation myocardial infarction. More recently, the HORIZONS-AMI randomized, open-label, multicenter trial has compared the efficacy and safety of bivalirudin alone versus UFH plus a GPI in 3602 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clinical results derived from this large study, including the final 3-year follow-up data, will be reviewed in the present clinical trial report.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary*
  • Antithrombins / adverse effects
  • Antithrombins / therapeutic use*
  • Combined Modality Therapy
  • Drug Therapy, Combination
  • Heparin / therapeutic use*
  • Hirudins / adverse effects
  • Humans
  • Myocardial Infarction / complications
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Peptide Fragments / adverse effects
  • Peptide Fragments / therapeutic use*
  • Platelet Glycoprotein GPIIb-IIIa Complex / adverse effects
  • Platelet Glycoprotein GPIIb-IIIa Complex / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Recombinant Proteins / adverse effects
  • Recombinant Proteins / therapeutic use
  • Treatment Outcome


  • Antithrombins
  • Hirudins
  • Peptide Fragments
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Recombinant Proteins
  • Heparin
  • bivalirudin