Wang Y, et al. - In this single-center prospective randomized controlled trial, researchers evaluated the efficacy and safety of bivalirudin during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in 123 high-bleeding-risk elderly patients who were assigned to either the unfractionated heparin (UFH) group (n = 55) or the bivalirudin group (n = 68). They reported 17.6% and 20.0% of major adverse cardiac events (MACE) incidence in the bivalirudin and UFH groups, respectively. They noted comparable Bleeding Academic Research Consortium (BARC) type 1–2 bleeding events during hospitalization in both the groups (UFH: 10.9% vs bivalirudin: 8.8%). The groups had comparable MACE incidence at the 6-month follow-up (UFH: 3.6% vs bivalirudin: 1.5%). Comparable MACE-free survival rates were noted between the groups. Overall, findings highlighted comparable efficacy and safety of bivalirudin vs UFH in elderly patients with a high bleeding risk, undergoing PCI for CTO lesions.