The use of adjunctive anticoagulants in patients with acute coronary syndrome transitioning to percutaneous coronary intervention.

Abstract

Patients presenting to the Emergency Department (ED) need to be quickly diagnosed, risk-stratified, and treated accordingly. Anticoagulants used in the ED should be easy to use and suitable for all patients with acute coronary syndromes, regardless of treatment strategy. In patients with ST-segment myocardial infarction, current guidelines recommend unfractionated heparin regardless of reperfusion strategy or low-molecular-weight heparin (LMWH) as an alternative in patients undergoing percutaneous coronary intervention (PCI). The LMWH enoxaparin is approved for ST-segment elevation myocardial infarction patients managed medically or undergoing PCI. The recently updated American College of Cardiology/American Heart Association guidelines for patients with unstable angina or non-ST-segment elevation myocardial infarction recommend unfractionated heparin or the LMWH enoxaparin (class IA recommendation), or the factor Xa inhibitor fondaparinux or the direct thrombin inhibitor bivalirudin (class IB recommendation) for patients managed invasively. This review discusses each of these anticoagulant options in the context of patients transitioning to PCI.

• Authors: Marc Cohen, James Hoekstra
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 26 Issue 8 Pg. 932-41 (Oct 2008) ISSN: 1532-8171 [Electronic] United States
• PMID: 18926355 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Anticoagulants

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy)
• Anticoagulants (therapeutic use)
• Clinical Trials as Topic
• Combined Modality Therapy
• Emergency Service, Hospital
• Humans
• Myocardial Revascularization (methods)
• Practice Guidelines as Topic
• Thrombolytic Therapy (methods)