Wednesday, December 8, 2021

Antocoagulation after reperfusion therapy

 Q: Which of the following is most unlikely to be used as anticoagulation after fibrinolytic therapy in acute ST-elevation myocardial infarction (STEMI)? (select one)

A) enoxaparin 

B) unfractionated heparin 

C) fondaparinux 

D) bivalirudin

Answer: D

Most cardiologists follow STEMI patients who receive fibrinolytic therapy with an anticoagulant. Unfractionated heparin (choice A) is usually the treatment of choice as it can be easily measured with PTT, has a relatively short half-life, and easy to maneuver if coronary stent is carried out. 

Many clinicians prefer enoxaparin (choice B) as literature leans towards its efficacy after fibrinolytic therapy, and less danger of Heparin-Induced Thrombocytopenia (HIT). 

Fondaparinux (choice C) is not the first line of choice in this situation but can be used if required. 

Bivalirudin (angiomax) (choice D) is usually avoided as evidence shows increased risk of moderate bleeding. Also, there is no data available to compare it with Placebo. This may change in the future if more data is available.



White H, Hirulog and Early Reperfusion or Occlusion (HERO)-2 Trial Investigators. Thrombin-specific anticoagulation with bivalirudin versus heparin in patients receiving fibrinolytic therapy for acute myocardial infarction: the HERO-2 randomised trial. Lancet 2001; 358:1855.

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