OBJECTIVES: Bivalirudin, a selective thrombin inhibitor, has been approved as an alternative treatment to the use of heparin in patients undergoing percutaneous coronary intervention (PCI). The objective is to evaluate the efficiency measured as the health care costs savings, due to the replacement of the current heparin plus glycoprotein IIb/IIIa inhibition (abciximab) by bivalirudin in patients undergoing PCI. METHODS: Regarding the incidence of ischaemic events, it has been proved the equivalence between heparin plus inhibitors of glycoprotein and bivalirudin, noticing a smaller rate of bleeding complications in the group treated with bivalirudin (REPLACE 2). Based on this finding a cost minimization analysis (CMA) has been carried out focusing on the differential costs when using both treatments: the drug cost, the cost of major bleeding management ( bleeding at puncture point and digestive bleeding). Two experts in interventionist cardiology verified the cost of the management of bleeding complications. RESULTS: The management cost of 100 patients subjected to PCI and treated with heparin plus abciximab is €89,023.67, and €57,703.76 if treated with bivalirudin, which results in an incremental cost of €313.2 per patient . In the group of patients subjected to PCI, with the bivalirudin option, and without modifying the hospital budget, 54 out of 100 patients more could be treated with a similar level of protection and a smaller bleeding risk. CONCLUSIONS: Bivalirudina should be considered as the anticoagulant first option in those patients undergoing PCI and that are currently receving heparin plus glycoprotein IIb/IIIa inhibition.