impact of sex on comparative outcomes of bivalirudin versus unfractionated heparin in patients with acute coronary syndromes undergoing invasive management a prespecified analysis of the matrix trial aims our aim was to assess whether bivalirudin compared with unfractionated heparin ufh is associated with consistent outcomes in males and females with acute coronary syndrome acs undergoing invasive managementmethods and results in the matrix programme 7213 patients were randomised to bivalirudin or ufh patients in the bivalirudin group were subsequently randomly assigned to receive or not a postpci bivalirudin infusion the 30day coprimary outcomes were major adverse cardiovascular events mace defined as death myocardial infarction or stroke and net adverse clinical events nace defined as mace or major bleeding the primary outcome for the comparison of a postpci bivalirudin infusion with no postpci infusion was a composite of urgent target vessel revascularisation tvr definite stent thrombosis st or nace the rate of mace was not significantly lower with bivalirudin than with heparin in male rate ratio rr 090 95 confidence interval ci 075107 p022 and female patients rr 106 95 ci 080140 p067 without significant interaction pint031 nor was the rate of nace males rr 085 95 ci 072101 p007 females rr 098 95 ci 076128 p091 pint038 postpci bivalirudin infusion as compared with no infusion did not significantly decrease the rate of urgent tvr definite st or nace males rr 084 95 ci 066107 p015 females rr 106 95 ci 074153 p074 pint028conclusions in acs patients the rates of mace and nace were not significantly lower with bivalirudin than with ufh in both sexes the rate of the composite of urgent tvr definite st or nace was not significantly lower with a postpci bivalirudin infusion than with no postpci infusion in both sexes