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Anticoagulation in ST-Elevation Myocardial Infarction

Chirag Bavishi1, J Dawn Abbott1

  • 1Lifespan Cardiovascular Institute, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA; Warren Alpert Medical School at Brown University, 222 Richmond Street, Providence, RI 02903, USA.

Interventional Cardiology Clinics
|May 31, 2021
PubMed

Insights

Anticoagulation is crucial for ST-elevation myocardial infarction treatment. This review compares unfractionated heparin and bivalirudin in percutaneous coronary intervention, discussing current guidelines and special patient populations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Intravenous anticoagulation is a cornerstone in managing ST-elevation myocardial infarction (STEMI).
  • Primary percutaneous coronary intervention (PCI) is the predominant reperfusion method for STEMI.
  • Key anticoagulant choices include unfractionated heparin, enoxaparin, fondaparinux, and bivalirudin.

Purpose of the Study:

  • To review the mechanisms and pharmacodynamics of available intravenous anticoagulants for STEMI.
  • To compare outcomes of unfractionated heparin versus bivalirudin in contemporary PCI.
  • To outline current guideline recommendations and explore unresolved issues in anticoagulation for specific patient groups.

Main Methods:

  • Literature review and synthesis of pharmacodynamic data.
  • Analysis of clinical trial outcomes comparing unfractionated heparin and bivalirudin in PCI.
  • Examination of current practice guidelines and expert recommendations.

Main Results:

  • Detailed comparison of anticoagulant mechanisms and pharmacodynamic profiles.
  • Historical and contemporary outcome data for unfractionated heparin and bivalirudin in PCI.
  • Summary of current guideline-directed anticoagulation strategies for STEMI.

Conclusions:

  • Understanding anticoagulant properties is vital for optimal STEMI management.
  • The choice of anticoagulant impacts outcomes in PCI, with evolving evidence.
  • Further research is needed for anticoagulation in specific populations like women and CKD patients.

Keywords:
AnticoagulationClinical trialsPercutaneous coronary interventionST segment elevation myocardial infarction

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