Objective To evaluate the efficacy and safety of thrombin inhibitor, bivalirudin, in the patients with acute myocardial infarction (AMI) undergoing intra-aortic balloon pump (IABP) assisted percutaneous coronary intervention (PCI). Methods A retrospective study was performed on 92 AMI patients who received IABP-assisted PCI in our department from Jan 2013 to Sep 2015. Based on the anticoagulant therapy during perioperative period, the patients were assigned into bivalirudin group (n＝30) and heparin group (n＝62). The incidences of peri-operative bleeding and major adverse cardiac events (MACE) were compared between the 2 groups. Results The bivalirudin group had a lower rate of in-hospital bleeding, but without significant difference with the heparin group. However, the decline of platelet count after PCI was significantly lower in the bivalirudin group than in the heparin group (P＝0.002). In the follow-up period, there was no obvious difference in the incidence of MACE between 2 groups (P＞0.05). Conclusion Bivalirudin is effective and safe, and has mild effect on platelet count in AMI patients undergoing IABP-assisted PCI.