大出血是急性冠状动脉综合征患者经皮冠状动脉介入术治疗预后不佳和病死率增加的主要危险因素，并可导致住院时间延长和费用增加。因此，预防出血和治疗缺血同等重要。多项临床研究表明，直接凝血酶抑制剂比伐卢定可减少缺血事件，尤其在出血高危患者，可减少出血风险，现就比伐卢定在急性冠状动脉综合征患者经皮冠状动脉介入术中的应用做一综述。“,”Major bleeding remains a major risk factor for percutaneous coronary intervention of acute coronary syndromes and is asso-ciated with higher morbidity, mortality, prolonged hospital stay and costs.The recognition that bleeding is an important factor in patient out-comes, has meant that the prevention of bleeding has become as an important goal as the prevention of ischemia.The direct thrombin inhibi-tor bivalirudin has been shown to reduce ischemia, and importantly is associated with less bleeding.In this article we review evidence that supports the use of bivalirudin across all spectrums of coronary syndromes and percutaneous coronary intervention.