Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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“…One nonrandomized study compared dalteparin with UFH in STEMI patients undergoing PCI and showed a neutral result (LOE 2). 437 …”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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“…Kim et al 34 have suggested that tirofiban in combination with dalteparin in patients with acute coronary syndrome can significantly lower the incidence of MACEs compared with UFH plus tirofiban. In our study, no significant differences in the incidence of MACEs or stent thrombosis were found between the two groups ( P =0.81 and 0.87).…”

Section: Discussionmentioning

confidence: 99%

The effect of dalteparin versus unfractionated heparin on the levels of troponin I and creatine kinase isoenzyme MB in elective percutaneous coronary intervention

Zhang

Cui

et al. 2014

Coronary Artery Disease

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BackgroundThe aim of this study was to investigate the safety and efficacy of dalteparin during an elective percutaneous coronary intervention (PCI) procedure in a large cohort.Materials and methodsIn this prospective, randomized, open-label design study, 733 patients undergoing elective PCI were divided into an unfractionated heparin group (group 1, 323 patients) or a dalteparin group (group 2, 410 patients). Blood samples were collected before and 18–24 h after the PCI procedure to determine the serum levels of cardiac troponin I (cTnI) and creatine kinase isoenzyme MB. Major adverse cardiac events (MACEs) and bleeding events during hospitalization were also recorded. Patients with an increased level of serum cTnI before PCI were excluded from the study.ResultsAfter PCI, the cTnI values were greater than three times the upper limit of normal in 43 cases (13.3%) in group 1 and 52 cases (12.7%) in group 2, without a statistically significant difference between the two groups (P=0.801). An increased creatine kinase isoenzyme MB level of greater than two times the upper limit of normal was found in 10 cases (3.1%) in group 1 and 12 cases (2.9%) in group 2, without a statistically significant difference between the two groups (P=0.894). Postoperative bleeding was observed in nine patients (2.8%) in group 1 and six patients (1.5%) in group 2. Postoperative MACEs were observed in two patients (0.6%) in group 1 and two patients (0.5%) in group 2. There were no significant differences between the two groups with respect to bleeding events or MACEs.ConclusionOur study showed that dalteparin might be as effective and safe as unfractionated heparin for anticoagulation during elective PCI.

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“…Data for other LMWHs such as dalteparin in PCI has been limited [23,24]. A recent study which directly compared dalteparin (70 IU/kg with GP IIb/IIIa inhibitors and 100 IU/kg dalteparin without it) with UFH, showed no significant difference in the composite of death, MI, target vessel revascularization, or bailout GP IIb/IIIa inhibitor at hospital discharge (13.7% in the UFH group and 13.1% in the dalteparin group) [25].…”

Section: Low-molecular Weight Heparinsmentioning

confidence: 99%

Adjunctive pharmacologic therapy in percutaneous coronary intervention

Kim

Giugliano

Jang

2011

Coronary Artery Disease

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Pharmacological adjuvant therapies to protect against procedure-related thrombotic complication are indispensable during percutaneous coronary intervention. In addition to antiplatelet therapy, use of anticoagulants to prevent acute thrombotic complication during percutaneous coronary intervention is essential. Besides unfractionated heparin (UFH), new anticoagulants have been developed and compared with UFH. Low-molecular weight heparins, direct thrombin inhibitors (e.g. bivalirudin), and recently developed agents such as fondaparinux (a factor Xa inhibitor) provide new alternatives to conventional UFH.

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Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

Cited by 8 publications

References 34 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

The effect of dalteparin versus unfractionated heparin on the levels of troponin I and creatine kinase isoenzyme MB in elective percutaneous coronary intervention

Adjunctive pharmacologic therapy in percutaneous coronary intervention

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