title: Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction? Insights from the HORIZONS-AMI trial.
abstract: OBJECTIVE
  Post-procedural anticoagulation (AC) for routine prophylaxis may be administered after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI), but the risks and benefits of this practice are uncertain. We therefore sought to assess the utility of routine post-procedural AC after primary PCI.
  
  
  RESULTS
  Patients undergoing primary PCI in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were grouped according to whether they received post-PCI AC for routine prophylaxis. Outcomes were assessed using propensity-adjusted multivariable analysis. Among 2932 patients in whom primary PCI for STEMI was performed, 869 (29.6%) received post-PCI AC for routine prophylaxis (median duration four days) and 2063 (70.4%) received no post-PCI AC. Time from PCI to ambulation was similar in both groups (median 0.9 vs 1.0 days, p=0.40), although hospitalization was prolonged in patients receiving AC for routine prophylaxis (median 6.0 vs 4.0 days, p<0.0001). After propensity-adjustment, patients who received and did not receive AC for routine prophylaxis after PCI experienced similar rates of 30-day adverse ischemic and major bleeding events. Deep venous thrombosis or pulmonary emboli developed rarely (0.3%) within 30 days, and were not significantly reduced by use of post-PCI AC for routine prophylaxis.
  
  
  CONCLUSIONS
  In this large-scale prospective study, use of post-procedural AC for routine prophylaxis was relatively common, and was not associated with improved clinical outcomes, although the duration of hospitalization was prolonged. These data suggest that post-PCI AC for routine prophylaxis may not provide benefit after successful primary PCI in patients in whom early ambulation is likely.
authors.affiliation: 1 Columbia University Medical Center, New York-Presbyterian Hospital, USA.
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Madhavan
authors.affiliation: 1 Columbia University Medical Center, New York-Presbyterian Hospital, USA.|3 Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: 1 Columbia University Medical Center, New York-Presbyterian Hospital, USA.|2 Cardiovascular Research Foundation, USA.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: 2 Cardiovascular Research Foundation, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: 4 Helios Amper-Klinikum, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.affiliation: 2 Cardiovascular Research Foundation, USA.|5 Icahn School of Medicine at Mount Sinai, USA.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: 1 Columbia University Medical Center, New York-Presbyterian Hospital, USA.|2 Cardiovascular Research Foundation, USA.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D055502:Secondary Prevention / Q000379:methods; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; C074619:bivalirudin
keywords: ST-segment elevation myocardial infarction; anticoagulation; bleeding; percutaneous coronary intervention