Abstract: AIM To determine the effects of bivalirudin on coagulation function and prognosis in women with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS A total of 71 women with coronary artery disease were assigned to two groups: Bivalirudin group (n=32) and heparin group (n=39). Activated clotting time (ACT) was determined at preoperative, 5 min after medication, immediately after operation, and 30 min, 1 h and 2 h after stopping medication. Before operation, and 6 h, 24 h and 72 h after stopping medication, thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (FIB) index were detected using automated coagulation analyzer. Before operation and 24 h after operation, a platelet count was performed. Net adverse clinical events (NACE) and stent thrombosis at 30-day were compared. RESULTS At 5 min after medication and immediately after operation, ACT in the bivalirudin group was significantly higher (P<0.01) and no significant difference was found at 30 min after stopping medication and preoperatively between the two groups. At 1 h and 2 h after stopping medication, ACT was significantly lower in the bivalirudin group (P<0.01). No significant difference was found in blood coagulation and platelet count after operation between the two groups and the 30-day follow-up revealed no difference in stent thrombosis and in major adverse cardiac or cerebral event between the two groups. All bleeding at 30 days and BARC types 2 through 5 were significantly reduced by using bivalirudin compared with using heparin (P<0.05). CONCLUSION Compared with heparin, bivalirudin produces better effects and quicker recovery and bivalirudin is thus safer and more efficient for women with coronary artery disease undergoing PCI.