Use of anticoagulants in ST-segment elevation myocardial infarction patients; a focus on low-molecular-weight heparin.
BACKGROUND
Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI), but given logistics, many patients are still managed with thrombolytics. Unfractionated heparin (UFH) is recommended for routine use in STEMI patients treated with thrombolytics. However, other anticoagulants have been evaluated for use in STEMI patients treated with thrombolysis, including the low-molecular-weight heparins (LMWHs, enoxaparin, dalteparin, and reviparin), fondaparinux and bivalirudin.


RESULTS
A review of the available randomized controlled study data shows that most evidence, in terms of number of trials and number of patients treated with anticoagulants in STEMI has accumulated for LMWHs. The use of enoxaparin and reviparin improves hard clinical efficacy endpoints although there is an excess of bleeding events. Trials with dalteparin have failed to demonstrate improvement in hard clinical efficacy endpoints compared with UFH.


CONCLUSIONS
Enoxaparin is currently the only LMWH with FDA approval for use in STEMI patients and should be considered as a preferable alternative to UFH in STEMI patients treated with fibrinolysis.
Gurm
Hitinder S
HS
University of Michigan Cardiovascular Center, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109-5852, USA.
Eagle
Kim A
KA
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight