Progress in cardiovascular diseases
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Prog Cardiovasc Dis · Nov 2015
ReviewThe Ideal Anticoagulation Strategy in ST-Elevation Myocardial Infarction.
Heparin has been the principal anticoagulant in the management of ST-elevation myocardial infarction (STEMI) but has several limitations. Although glycoprotein IIb/IIIa inhibitors have been major adjuncts in previous years, in the era of novel P2Y12 receptor inhibitors they may have a greater role in bailout. ⋯ The direct thrombin inhibitor bivalirudin overcomes several shortcomings of heparins and has demonstrated a significant reduction in bleeding outcomes and net adverse cardiac events at the cost of increased acute stent thrombosis. This review discusses the pharmacology and clinical trial evidence for different anticoagulant treatment options in STEMI with a proposed selection strategy in contemporary primary PCI.