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...
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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]

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