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Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin

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Abstract

Introduction

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.

Methods and 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.

Summary

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.

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Acknowledgments

The authors received editorial/writing support in the preparation of this manuscript, funded by sanofi-aventis, NJ, USA. The authors assume all responsibility for the content and integrity of this manuscript.

Conflicts of interest

Hitinder S. Gurm has received grant support from the Nordgren foundation and has served as a consultant to Icon Interventional Systems and Cardiomems Inc. Kim A. Eagle has received grants from sanofi-aventis, Mardigian Foundation, SE Michigan Community Foundation, Ann Arbor Area Community foundation, Pfizer and Bristol Myers Squibb. He has also acted as a consultant to the National Heart Lung and Blood institute and the Robert Wood Johnson Foundation.

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Authors and Affiliations

  1. University of Michigan Cardiovascular Center, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA

    Hitinder S. Gurm & Kim A. Eagle

  2. University of Michigan Cardiovascular Center, 1500 East Medical Center Drive, Suite 2131, Ann Arbor, MI, 48109-5852, USA

    Kim A. Eagle

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Correspondence to Kim A. Eagle.

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Gurm, H.S., Eagle, K.A. Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin. Cardiovasc Drugs Ther 22, 59–69 (2008). https://doi.org/10.1007/s10557-007-6077-4

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