Anticoagulationisimperativetoreducetheincidenceofthromboticcomplicationsinpatientsundergoingpercutaneousinterventionalcardiovascularprocedures;however,thisisattheexpenseofincreasedriskofbleeding.Theoptimalanticoagulationstrategyfortheseproceduresremainsunclear.Unfractionatedheparinisthemostcommonlyusedanticoagulantduringinterventionalprocedures,buthasseverallimitations,suchasrelativelyhighincidenceofbleedingevents,occurrenceofheparin-inducedthrombocytopenia,andaparadoxicalthromboticeffect.Contemporarystudieshavedemonstratedthatbivalirudindecreasestheoccurrenceofbleedingcomplications,butpotentiallyincreasestheriskofacutestentthrombosis.Thisreviewdiscussesthepharmacologyofbivalirudinanditscurrentclinicalapplicationinpatientsundergoingpercutaneouscoronaryinterventionandtranscatheteraorticvalvereplacementprocedures.