ACRIPAB- Trial: Anti Coagulation Regimen In High Risk PAtients for Bleeding

To determine the safety/efficacy of Bivallirudin Vs unfractionated heparin (UFH) on top of dual antiplatelet therapy in patients with high tendency for bleeding during urgent and elective PCI.

Inclusion Criteria:

Inclusion criteria (any of the following):

• ≥75 years
• Creatinin clearance rate < 60 ml per minute
• Anemia (Hb 9-11 mg%)
• Hypertension: BP > 180/95 mmHg but less than 210/110 m Hg
• Diabetic Pts
• Steroid treated Pts
• Recent (within 6 weeks) non major surgery
• Pts with hematological disorders associated with tendency for bleeding like Thrombocytopenia (platelets 50000-150000) included TTP;

Exclusion Criteria:

Exclusion criteria:

• Age < 18 year
• Acute STEMI (Primary PCI)*
• Rescue angioplasty <12h after lytic therapy*
• Active bleeding
• S.C LMWH < 8 hours or UFH < 4 hours before PCI
• Using IIb /IIIa as an upstream therapy before PCI
• PCI which will be involved with obligatory IIb /IIIa therapy:

(thrombotic complication, occlusive dissection)

• INR>1.5 on day of cathetrization
• Bolus of 600mg of Clopidogrel before PCI
• Current pregnancy or women in reproductive age without contraceptives
• Hypersensitivity to heparin or bivalirudin or its components *(possible using IIB/IIIA)