<International Circulation>: Bivalirudin has been included as a class-one recommendation as an anticoagulant therapy for primary PCI.  Do you have a view on this change?
 
    Roxana Mehran:Of course I do， because I conducted the HORIZONS AMI study and I think that was the one trial where we showed that by having a drug that was associated with less bleeding we actually saved lives and we did not have to pay any tax  on ischemic complications， so I think that is a fantastic choice.  The one piece we have to work out is the stent thrombosis.  Prasugrel seems to be the right fit， but it needs to be studied in order to say that it should be applied， across the board， to all STEMI patients.

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