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ISCHAEMIC HEART DISEASE
The REPLACE-2 (Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events) trial showed that bivalirudin monotherapy, when compared with unfractionated heparin and glycoprotein (GP) IIb/IIIa inhibitors, led to similar rates of ischaemia and death in patients with stable or unstable angina undergoing percutaneous coronary intervention (PCI), but that rates of major and minor bleeding were significantly reduced. The ACUITY (Acute Catheterization and Urgent Intervention Strategy) trial was a prospective, randomised, multi-centre trial that compared a regimen of heparin and a glycoprotein IIb/IIIa inhibitor against bivalirudin plus a glycoprotein IIb/IIIa inhibitor or against bivalirudin alone in patients with moderate or high-risk acute coronary syndromes (ACS) undergoing an early invasive strategy. There were 13 819 patients with ACS randomised to one of these three antithrombotic regimens. The primary end points were a composite ischaemia end point (death, myocardial infarction or unplanned revascularisation for ischaemia), major bleeding, and the net clinical outcome
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