Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter?

Giralt, Teresa; Ribas, Núria; Freixa, Xavier; Sabaté, Manel; Caldentey, Guillem; Tizón‐Marcos, Helena; Carrillo, Xavier; García-Picart, Joan; Lidón, Rosa María; Cárdenas, M; Pérez‐Fernández, Silvia; Mauri, Josepa; Vaquerizo, Beatriz

doi:10.1016/j.ijcard.2020.09.058

Cited by 6 publications

(8 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, in two studies by Giralt et al (13,14), both having significant weight in our meta-analysis, the authors witnessed a sustained reduction in mortality outcomes, whether in-hospital, 30-day or 1-year mortality, and lower rates of in-hospital cardiogenic shock. However, both analyses showed similar grades of major bleeding events between groups despite a slight no-benefit-tendency in the pretreatment group.…”

Section: Risk Of Bias and Evidence Certaintymentioning

confidence: 70%

“…Following duplicate removal, 525 publications were excluded based on pre-defined inclusion and exclusion criteria. Finally, 14 studies, 4 RCTs (2,5-7) and 10 observational studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17), were included (Figure 1) with a total of 76446 patients: 31238 in the pretreatment group and 39208 in the control group. Most studies used UFH doses between 5000-10000 U or 90 U/kg.…”

Section: Search Resultsmentioning

confidence: 99%

“…Despite the widespread use of UFH during PCI, robust evidence is scarce on the benefits of administering anticoagulation at earlier stages within a PCI context. To date, only four small randomised controlled trials (RCTs) (2,(5)(6)(7) and several observational studies (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) with varying results on patient-relevant outcomes have investigated UFH pretreatment in patients with STEMI undergoing PCI. Additionally, the evidence on mortality outcomes remains inconclusive.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pretreatment of patients with ST-segment elevation myocardial infarction with heparin: a systematic review and meta-analysis

Costa,

Resende,

Oliveiros

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). However, current guidelines do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterisation laboratory. Methods: Between June and July 2023, we systematically searched PubMed, Embase and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A random-effects meta-analysis and meta-regression analyses were performed. Results: Fourteen studies were included, of which four were randomised clinical trials (RCTs). A total of 76446 patients were included: 31238 in the pretreatment group and 39208 in the control group. Our meta-analysis revealed a lower all-cause mortality for the pretreatment strategy when compared with the control group, albeit with high heterogeneity (pooled odds ratio (OR) = 0.61, 95% confidence interval (CI) [0.49 - 0.76], P < 0.01; I2 = 77%); lower in-hospital cardiogenic shock (pooled OR = 0.68, 95% CI [0.58, 0.78], P < 0.21; I2 = 27%) and a higher rate of spontaneous reperfusion events (pooled OR = 1.68, 95% CI [1.47, 1.91], P < 0.01; I2 = 79%). In terms of major bleeding, the UFH pretreatment strategy further revealed a decreased rate of events (pooled OR = 0.85, 95% CI [0.73, 0.99], P = 0.40; I2 = 4%). Conclusions: Our study suggests that UFH pretreatment in patients with STEMI undergoing primary PCI was associated to reduced all-cause mortality, cardiogenic shock, enhancing reperfusion rates, whilst diminishing major bleeding events.

show abstract

Section: Risk Of Bias and Evidence Certaintymentioning

confidence: 70%

Section: Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pretreatment of patients with ST-segment elevation myocardial infarction with heparin: a systematic review and meta-analysis

Costa,

Resende,

Oliveiros

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Giralt et al showed that early heparin administration results in higher artery patency in a time-dependent manner and improves clinical outcomes [ 15 ]. Also, they showed that the sooner the heparin is administered, the better, with improved clinical outcomes [ 15 ]. An insight from the TOTAL clinical trial, using the same population but analyzing the effect of upstream anticoagulation with heparin on artery patency and thrombus, showed that pre-PCI anticoagulation was associated with improved flow and reduced thrombus burden, with non-significant differences regarding clinical outcomes [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI

Bataila,

Popa-Fotea,

Cojocaru

et al. 2024

JCM

View full text Add to dashboard Cite

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

show abstract

Upstream anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter?

Cited by 6 publications

References 29 publications

Pretreatment of patients with ST-segment elevation myocardial infarction with heparin: a systematic review and meta-analysis

Pretreatment of patients with ST-segment elevation myocardial infarction with heparin: a systematic review and meta-analysis

Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI

Upstream anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

Contact Info

Product

Resources

About