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[Correspondence] Bivalirudin versus heparin use for patients undergoing PPCI

Although randomised clinical trials are the gold standard used to define treatment recommendations, beneficial effects of a drug for treatment might be obscured because of the effect of adjunctive treatment on patient outcomes. The GUSTO trial investigators1 reported that treatment of ST-segment elevation myocardial infarction (STEMI) with tissue plasminogen activator reduced mortality compared with the use of streptokinase. To show this benefit, effective adjunctive treatment with intravenous heparin was necessary.