[Prescription of heparin in the acute phase of myocardial infarction: expected and observed benefits...].
Before the advent of thrombolysis, heparin was widely used in the acute phase of myocardial infarction. Its prescription was based on trials, often of criticable methodology, some of which showed a reduction in hospital mortality and others a reduction in the incidence of reinfarction, left ventricular thrombi or venous thromboembolism. A better understanding of physiopathology and the development of emergency methods of myocardial reperfusion (pharmacological or mechanical) showed that the real objective of management of acute myocardial infarction should be reopening of the occluded artery and the maintenance of its patency. Reocclusion which occurs in 20% of cases in associated with increased hospital morbidity and mortality. Heparin, which limits the paradoxial increase of thrombin after thrombolysis significantly decreases this risk. Two reference trials on the benefits of heparin in association with thrombolysis, GISSI-2 and ISIS-3, demonstrated a significant reduction in the 7 day mortality but no significant reduction in the 35 day mortality. The poor quality of the anticoagulation protocol, especially in patients receiving rtPA, explains these disappointing results. Thus, it has now been clearly established that heparin, even though it increases the number of bleeding complications should be associated early and at an appropriate dosage with all thrombolytic regimes or mechanical reperfusion methods used during acute myocardial infarction. Apart from the embolic complications or ventricular thrombosis, this anticoagulation only seems to be justified during the first 48 hours.
Cador
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Service de cardiologie, hôpital Cochin, Paris.
Weber
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D000925:Anticoagulants / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D015425:Myocardial Reperfusion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin
Prescription d'héparine au cours de l'infarctus du myocarde en phase aiguë: bénéfices attendus, bénéfices constatés...