How do unfractionated and low-molecular-weight heparin compare after ST-segment elevation MI?
A Michael Lincoff
Correspondence Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
Email lincofa@ccf.org
This article has no abstract so we have provided the first paragraph of the full text.
Myocardial reperfusion by pharmacologic fibrinolysis or percutaneous coronary revascularization is the mainstay of early acute myocardial infarction (AMI) management. Antithrombotic agents are employed as adjuncts to fibrinolysis to improve patency and reduce reocclusion. Large-scale trials have confirmed that aspirin diminishes mortality and recurrent ischemia or infarction as an adjunct to fibrinolysis.1 UFH or LMWH are also administered commonly with fibrinolytic therapy; however, the body of evidence supporting the efficacy of these agents has, until recently, been largely inferential and much less robust than that for aspirin. Only four small trials carried out more than a decade ago have randomized patients to receive UFH or no heparin with fibrinolysis. These studies had insufficient power to show reductions in mortality or reinfarction with heparin, although bleeding risk was clearly increased with this drug. Nevertheless, as early angiographic studies suggested that infarct-vessel patency is improved with heparin, guidelines recommend that heparin be administered during and after fibrinolytic therapy.
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