What was the outcome of the ACUITY trial?
The ACUITY trial evaluated unfractionated heparin (UFH) versus bivalirudin with or without GP IIb/IIIa inhibitors. The rates of composite ischemia (death, MI, unplanned revascularization) in patients who received bivalirudin alone compared with those who received UFH plus GP IIb/IIIa inhibitors were similar (9% versus 9%). Fewer patients experienced major bleeding with bivalirudin alone than did with heparin plus GP IIb/IIIa inhibitors (4% versus 7%; relative risk [RR]: 0.52; 95% confidence interval [CI]: 0.35-0.76). The deferred GP IIb/IIIa inhibitors reduced the 30-day rates of major bleeding compared with upstream administration (7.9% versus 7.1%; OR: 0.89; 95% CI: 0.76-1.03; P = 0.14 for non-inferiority; P = 0.13 for superiority). 