The Scottish Medicines Consortium (SMC) has published advice on the use of bivalirudin (Angiox®) as an anticoagulant in adult patients undergoing percutaneous coronary intervention (PCI), including patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.  It is accepted within NHS Scotland for this indication, restricted to those patients who would have been considered for treatment with heparin in combination with a glycoprotein IIb/IIIa inhibitor.  It should not be used as an alternative to heparin alone.

The drug advice (see link below) notes that in patients with STEMI undergoing PCI, bivalirudin, compared with heparin plus a glycoprotein IIb/IIIa inhibitor, was associated with significantly lower rates of major bleeding, cardiac death and thrombocytopenia.