OBJECTIVES:The choice of anticoagulant strategy in PCI affects the costs of treatment for patients with AMI. Given the economic constraints of a fixed per-case payment based on DRGs in Germany, anticoagulant strategy must not only offer medical benefits for the patient but also be economically acceptable for hospitals. Therefore the in-hospital costs of using different anticoagulants in a real-world setting are highly relevant from a hospital perspective. Based on administrative hospital data the purpose of this study was to determine the economic impact of routinely used anticoagulant strategies in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in Germany. METHODS:We analyzed in a real-world scenario administrative routine data from 1409 patients undergoing PCI for AMI in two high-volume german PCI centers. In-hospital costs of contemporary antithrombotic strategies, in detail 1) unfractionated heparin (UFH) monotherapy (nϭ953); 2) UFH ϩ glycoprotein IIb/IIIa receptor inhibitor (GPI; nϭ337); or 3) bivalirudin (nϭ119) were calculated based on the observed resource utilization. RESULTS: Baseline characteristics were well balanced and clinical outcomes were similar for all groups though not powered for difference. Total length of stay (LOS) and time spent in ICU was lowest with bivalirudin. Therefore in-hospital costs were lowest with bivalirudin (UFH: 3807,2€ Ϯ 2235,98€; UFHϩGPI: 4643,15Ϯ 4662,48€; bivalirudin: 3461,82€ Ϯ 1301,96€). CONCLUSIONS: Compared with UFH monotherapy and UFH ϩ GPI, the use of bivalirudin among patients undergoing PCI for AMI in Germany results in a shorter ICU and total LOS and appears to reduce in-hospital costs.