How is anticoagulation used in patients receiving fibrinolytic therapy for the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

In patients receiving fibrinolytic therapy, anticoagulation should be given until revascularization is performed; if reperfusion is not feasible anticoagulants should be given for at least 48 hours or for the duration of hospital stay up to 8 days. [4]  UFH or LMWH may be used, with LMWH (enoxaparin) being preferred. [88, 89, 90]  Use caution with the administration of enoxaparin in patients older than 75 years as well as those with impaired renal function, because the use of enoxaparin is associated with a higher risk of intracranial bleeding. Bivalirudin may be used for patients who develop or have a history of heparin-induced thrombocytopenia (HIT) and require anticoagulation. [91]


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