Interv Akut Kardiol. 2020;19(3):163-165 | DOI: 10.36290/kar.2020.039
Initial dose of acetylsalicylic acid and heparin in a patient with STEMI
- Kardiocentrum 3. LF UK a FNKV, Praha
Acute myocardial infarction most commonly occurs as a result of a thrombotic occlusion of a coronary artery that originates as a consequence of an unstable atherosclerotic plaque rupture. Early reperfusion of the infarct related artery is a crucial factor in treating patients with myocardial infarction. For this purpose, primary percutaneous coronary intervention is currently performed. In a small proportion of patients meeting the indication criteria, it is possible to administer thrombolytic therapy. Antithrombotic therapy is a part of both these above-mentioned reperfusion modalities. Acetylsalicylic acid has long been the mainstay of treatment of all forms of ischaemic heart disease, including acute myocardial infarction. The administration of both unfractionated and low-molecular-weight heparin is of equal importance. The article deals with the initial treatment of acute ST-elevation myocardial infarction patients using acetylsalicylic acid and heparins and with its dosage.
Keywords: acute myocardial infarction, heparin, acetylsalicylic acid.
Published: September 2, 2020 Show citation
References
- Mo»ovská Z, Widimský P. Protidestičková léčba ischemické choroby srdeční. Postgraduální medicína 2008; 7: 718-723.
- Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a Veterans Administration Cooperative Society. N Engl J Med 1983; 309: 396-403.
Go to original source... - Cairns JA, Gent M, Singer J, et al. Aspirin, sulphinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med 1985; 313: 1369-1375. Go to original source...
- Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med 1988; 319: 1105-1111. Go to original source...
- Research Group on Instability in Coronary Artery Disease in Southeast Sweden (RISC). Aspirin (75 mg/day) after an episode of unstable coronary artery disease: long-term effects on the risk of myocardial infarction, occurrence of severe angina and the need for revascularisation. J Am Coll Cardiol 1991; 18: 1587-1593. Go to original source...
- Kenaan M, Seth M, Aronow HD, et al. The clinical outcomes of percutaneous coronary intervention performed without pre-procedural aspirin. J Am Coll Cardiol 2013; 62(22): 2083-2089. Go to original source...
- Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988; 2(8607): 349-360.
- Ibanez B, James S, Agewall S, et al.; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal 2018; 39: 119-177. Go to original source...
- Liem A, Zijlstra F, Ottervanger JP, et al. High dose heparin as pretreatment for primary angioplasty in acute myocardial infarction: the Heparin in Early Patency (HEAP) randomized trial. J Am Coll Cardiol. 2000; 35(3): 600-604. Go to original source...
- Montalescot G, Zeymer U, Silvain J, et al.; ATOLL Investigators. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for STelevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 2011; 378(9792): 693-703. Go to original source...
- Collet JP, Huber K, Cohen M, et al.; ATOLL Investigators. A direct comparison of intravenous enoxaparin with unfractionated heparin in primary percutaneous coronary intervention (from the ATOLL trial). Am J Cardiol 2013; 112(9): 1367-1372. Go to original source...
- Silvain J, Beygui F, Barthelemy O, et al. Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. BMJ 2012; 344: e553. Go to original source...
Go to PubMed... - Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet 2001; 358(9282): 605-613.
- Giraldez RR, Nicolau JC, Corbalan R, et al. Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: an ExTRACT-TIMI 25 analysis. Eur Heart J 2007; 28(13): 1566-1573. Go to original source... Go to PubMed...
- White HD, Braunwald E, Murphy SA, et al. Enoxaparin vs. unfractionated heparin with fibrinolysis for STelevation myocardial infarction in elderly and younger patients: results from ExTRACT-TIMI 25. Eur Heart J 2007; 28(9): 1066-1071. Go to original source... Go to PubMed...