Summary
The treatment of ST-segment elevation myocardial infarction (STEMI) has improved over
the past decades, mainly due to reperfusion therapies. The aim of this article is
to provide an updated review of adjunctive antithrombotic therapy to reperfusion strategies
for STEMI. As compared to unfractionated heparin (UFH), among patients treated with
thrombolysis, low-molecular- weight heparins (LMWHs),mainly enoxaparin, fonda-parinux
and clopidogrel have been shown to improve outcome in terms of death and reinfarction,
whereas GP IIb-IIIa inhibitors, mainly abciximab, and direct thrombin inhibitors have
reduced reinfarction, but not mortality. Among patients undergoing primary angioplasty,
early UFH should still be regarded as the gold standard in anticoagulation therapy.
In addition to ASA, early GP IIb-IIIa inhibitors, especially abciximab, should be
considered since it has been shown to provide further benefits in terms of preprocedural
recanalization. Despite the positive results observed in the HORIZONS trial, additional
studies are needed to investigate the role of bivalirudin as compared to abciximab
administration. In our opinion, bivalirudin may be considered instead of GP IIb-IIIa
inhibitors among STEMI patients at high risk for bleeding complications. Due to the
very low mortality currently achieved by primary angioplasty, a further reduction
in short- or medium-term mortality would be quite improbable to be observed. Thus,
additional endpoints, such as infarct size and myocardial perfusion, may be considered
in future randomized trials among patients undergoing mechanical revascularization
for STEMI.
Keywords
Acute myocardial infarction - direct antithrombin agents - atherothrombosis - antiplatelet
drugs - heparins / LMWH
