Does VALIDATE-SWEDEHEART invalidate the use of bivalirudin in myocardial infarction?

Over the past two decades, technological advances in percutaneous coronary intervention (PCI) [such as 2^nd generation drug eluting stents (DES), use of transradial access] and antithrombotic therapy (more potent P2Y₁₂ agents) have made PCI safer and more effective in treating patients with acute coronary syndrome (ACS). The use of direct and indirect thrombin inhibitors along with glycoprotein IIb/IIIa inhibitors (GPI) during PCI have contributed to improved angiographic and clinical outcomes, but at the cost of increased bleeding complications and its attendant risks of morbidity and death (1).