Shah R, et al. - Researchers analyzed randomized controlled trials identified from scientific databases and websites to assess the safety and efficacy of switching to bivalirudin during primary percutaneous coronary intervention (PCI) for patients who received preprocedure unfractionated heparin (UFH). They classified patients into those who received heparin with or without glycoprotein IIb/IIIa inhibitors (heparin group); those switched to bivalirudin during primary PCI from preprocedure UFH (switch group); and those who received bivalirudin without preprocedure UFH (Biv-alone group). They carried out both traditional pairwise meta-analyses using moderator analyses and network meta-analyses using mixed-treatment comparison models. They analyzed 5 trials including 13,547 patients. Decreased rates for major bleeding, net adverse clinical events (NACEs), major adverse cardiovascular events (MACEs), and all-cause mortality were observed with the use of bivalirudin vs heparin +/− GPI during primary PCI for those receiving preprocedure UFH. Decreased rates for MACEs and all-cause mortality were offered by this strategy vs bivalirudin alone without preprocedure UFH.