Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction

Quinlan, Daniel J.; Eikelboom, John W.

doi:10.1001/archinternmed.2009.126

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…The lack of sICHs in the LMWH group supports a safer AC, whereas treatment with UFH seemed to be associated with sICH in propensity analysis. The heparin dosages and ICH rates in our cohort are in line with results from other studies and a similar LMWH regimen is used in both myocardial infarction and venous thromboembolic events with similar results, favoring LMWH with lower risk of hemorrhagic complications .…”

Section: Discussionsupporting

confidence: 90%

“…Although UFH may provide rapid effective AC, LMWH has a longer plasma half‐life and more stable and predictable dose response, and therefore has easier subcutaneous dosing and no need for laboratory monitoring . UFH has been replaced by LMWH in the treatment of several other medical conditions, due to better outcomes and safety . However, to our knowledge, no comparison between the safety and efficiency of UFH versus LMWH has been made in IVT‐treated patients with BAO.…”

Section: Introductionmentioning

confidence: 99%

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Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion

Ritvonen

Strbian

Silvennoinen

et al. 2018

Euro J of Neurology

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion

Ritvonen

Strbian

Silvennoinen

et al. 2018

Euro J of Neurology

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“…However, our current protocol advises a target of 2.0−2.5‐fold the baseline APTT levels and heparin dosing is adjusted by weight . At present, UFH has been replaced by low‐molecular‐weight heparin in most acute cardiac indications including ST‐elevation myocardial infarction .…”

Section: Discussionmentioning

confidence: 99%

Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion

Sairanen

Strbian

Ruuskanen

et al. 2014

Euro J of Neurology

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“…There were 2 neutral meta-analyses of dalteparin, nadroparin, reviparin, parnaparin (LOE 5), 413,414 1 dalteparin supporting study using a surrogate end point (LOE 1), 415 and 3 neutral studies of LOE 1 416 for nandroparin 416 and parniparin. 417,418 Fondaparinux. One study demonstrated superiority in clinical outcomes when fondaparinux was compared with UFH in patients treated with fibrinolysis (LOE 1).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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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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Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction

Cited by 6 publications

References 9 publications

Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion

Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion

Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion

Part 9: Acute Coronary Syndromes

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