Effects of the Early Administration of Heparin in Patients With ST-Elevation Myocardial Infarction Treated by Primary Angioplasty

Abstract

Background The effect of adjunctive heparin for primary angioplasty in patients with ST-elevation myocardial infarction (STEMI) is not well established, so the authors investigated the effect of early heparin administration in the emergency room (ER) on initial patency of the infarct-related artery (IRA) and on the clinical outcome in STEMI patients. Methods and Results One hundred and twenty consecutive patients who presented with STEMI less than 12 h from pain onset and who were eligible for primary percutaneous coronary intervention were allocated to an early heparin group (heparin administered in ER) or a late heparin group (heparin administered after angiography). In the early heparin group, unfractionated heparin (60 U/kg bolus IV, then 14 U·kg -1 ·h -1 IV infusion) or enoxaparin (1 mg/kg bolus SC) were administered 144±95 min before angioplasty. No significant differences in baseline characteristics were observed between the early heparin group (n=56) and the late heparin group (n=64). However, initial Thrombolysis In Myocardial Infarction (TIMI) flow grade in the IRA was significantly different between the 2 groups (frequency of TIMI 0/1/2/3; 48/4/7/41% vs 70/8/11/11%, early vs late respectively, p=0.002). TIMI 2 or 3 flow was significantly more frequent in the early heparin group than in the late heparin group (48% vs 22%, p=0.002). However, no significant differences were noted between the 2 groups in terms of in-hospital major adverse cardiac events (7% vs 11%, p=0.472) and TIMI major bleeding (2% vs 3%, p=0.639). Conclusions In STEMI patients, early heparin therapy administered in the ER improves coronary patency, despite not reaching clinical benefit. (Circ J 2007; 71: 862 -867)

Time-dependent effects of unfractionated heparin in patients with ST-elevation myocardial infarction transferred for primary angioplasty

“…A subsequent observational study, published two years later by the same Dutch group, showed pre-hospital UFH (≥ 5000 UI) was associated with higher IRA patency than when it was administered upon arrival to the PPCI-capable centre [15]. These latter findings have been supported by two additional international studies [16,17] and by our real-life cohort. In the present study, better TIMI flow grade 2-3 was observed in the pre-transfer group patients that received UFH early.…”

“…In the present study, better TIMI flow grade 2-3 was observed in the pre-transfer group patients that received UFH early. Of note, all patients received the same dose of UFH (5000 UI) before transfer, providing a homogeneous sample for suitable comparisons, as opposed to other studies whose protocol required that the UFH dosage was adjusted according to body weight [13] or even mixed patients treated either with heparin or enoxaparin (drugs with different pharmacokinetics and half-lives) [16]. Indeed, a standard and fixed dose makes easier the treatment protocol, helps emergency crews and physicians from non-PPCI centres to remember it and administer it fast, while reducing dosage errors.…”

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

“…14 Chung et al, showed that in STEMI patients, early heparin treatment in emergency improve coronary patency. 16 The difference between the findings of this study and other studies can be related to difference in the sample size, risk factors, angiographic characteristics and the time of reaching patients of pain start time to hospital and receiving treatment. For example in this study, heparin receiving patients had more coronary artery that completely affects the treatment and clinical outcomes of patients.…”

“…In fact, this study expresses that in STEMI patients, early heparin treatment in emergency leads to improvement coronary patency. 16 It is observed in this study that in case group in comparison to control group the rate of hematoma was higher (3.1% versus zero %) but not meaningful. The incidence rate of hematoma in different studies has been reported for different heparin receivers.…”

Simple Risk Algorithm to Predict Serious Bleeding in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…Other authors have shown that early use of heparin resulted in improved initial TIMI flow grade, angiographic thrombus burden and rate of slow-flow during the primary angioplasty procedure. 36 But, as in the present study, the use of heparin did not reduce the rate of in-hospital adverse cardiac events. In addition, women, older patients and patients with body mass index <25 had a higher risk of being over-anticoagulated during treatment with heparin.…”