In this episode, Dr. Valentin Fuster discusses a pivotal study comparing bivalirudin and heparin anticoagulation in STEMI patients undergoing primary PCI, highlighting that bivalirudin may reduce cardiac mortality and bleeding without increasing thrombotic events. While the findings challenge previous guidelines favoring heparin, limitations in the research prompt caution about immediate changes to clinical practice, emphasizing the need for further exploration of bivalirudin's role in diverse patient populations.