title: Confirmation that heparin is an alternative means of promoting early reperfusion.
abstract: BACKGROUND
  New strategies to increase coronary patency rate before primary angioplasty are under discussion. We tested the hypothesis that use of a high dose of a standard heparin bolus could achieve an acceptable rate of re-opening occluded infarct-related arteries thus providing an alternative to chemical thrombolysis before admission of the patient to hospital, and a pretreatment for primary angioplasty.
  
  
  METHODS
  Forty-eight patients who presented within 12 h of acute myocardial infarction with ST segment elevation were assigned randomly to groups to receive aspirin (200 mg orally) and high-dose standard heparin 300 U/kg as an intravenous bolus (n = 25), or aspirin and placebo bolus (n = 23). Thereafter, all patients underwent coronary arteriography to assess their suitability for primary angioplasty.
  
  
  RESULTS
  The high-dose heparin group had greater patency rate (Thrombolysis in Myocardial Infarction grade 2 or 3 flow in the infarct-related artery) than the placebo group (52% compared with 13%, P = 0.006). Hemorrhages related to the puncture site that required blood transfusion occurred in two of 25 and in one of 23 patients in the high-dose heparin and placebo groups, respectively.
  
  
  CONCLUSIONS
  Our study suggests that high-dose standard heparin does have a thrombolytic action when administered as an intravenous bolus.
authors.affiliation: Coronary Care Unit, Hospital Português and Fundação Bahiana de Cardiologia, Salvador, Brazil.
authors.forename: J C
authors.initials: JC
authors.lastname: Braga
authors.forename: F P
authors.initials: FP
authors.lastname: Esteves
authors.forename: J P
authors.initials: JP
authors.lastname: Esteves
authors.forename: A L
authors.initials: AL
authors.lastname: Latado
authors.forename: A G
authors.initials: AG
authors.lastname: Godinho
authors.forename: A
authors.initials: A
authors.lastname: Azevedo Júnior
authors.forename: J C
authors.initials: JC
authors.lastname: Brito
authors.forename: P R
authors.initials: PR
authors.lastname: Silva
authors.forename: M S
authors.initials: MS
authors.lastname: Teixeira
authors.forename: V P
authors.initials: VP
authors.lastname: Souza
authors.forename: A
authors.initials: A
authors.lastname: Rabelo Júnior
authors.forename: M S
authors.initials: MS
authors.lastname: Rocha
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D001241:Aspirin