What are the 2013 ACC/AHA guidelines for antithrombotic therapy in patients undergoing primary PCI for 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...
  • Print
Answer

In the 2013 ACC/AHA guidelines for management of STEMI, recommendations for antithrombotic therapy in patients undergoing primary PCI include those below [2] :

Class I

  • For supportive anticoagulant therapy: Unfractionated heparin (UFH), with additional boluses as needed to maintain therapeutic activated clotting time levels, accounting for whether a GP IIb/IIIa receptor antagonist has been administered (level of evidence: C); or bivalirudin with/without UFH prior therapy. (Level of evidence: B)

Class IIa

  • For STEMI patients at high risk of bleeding, bivalirudin monotherapy may be preferred over the combination of UFH and a GP IIb/IIIa receptor antagonist. (Level of evidence: B)

Class III

  • PCI should not be performed with fondaparinux as the sole antithrombin agent. (Level of evidence: B)

 

The 2014 ESC/EACTS and the 2017 ESC guidelines vary from ACC/AHA in that use of both bivalirudin and enoxaparin (with/without GP IIb/IIIa receptor antagonist) are given a class IIa recommendation. [127, 70]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!