PMID- 26934662
OWN - NLM
STAT- MEDLINE
DCOM- 20170525
LR  - 20170525
IS  - 1827-1618 (Electronic)
IS  - 0026-4725 (Linking)
VI  - 64
IP  - 3
DP  - 2016 Jun
TI  - Optimizing adjunctive antithrombotic and anticoagulant therapy in primary PCI for 
      STEMI.
PG  - 238-55
AB  - The pharmacological management of patients with ST elevation myocardial 
      infarction (STEMI) poses a significant challenge to the clinician. While 
      mechanical reperfusion with primary percutaneous coronary intervention (PPCI) has 
      proved its superiority over fibrinolysis, the best antithrombotic strategy 
      surrounding the procedure remains a matter of debate. Due to the high risk of 
      bleeding induced by antithrombotic drugs, the pharmacological management of STEMI 
      needs to focus on an optimal strategy that reduces the rate of coronary 
      thrombotic events without leading to excess bleeding. Intravenous anticoagulants 
      are recommended for all patients presenting with STEMI. Low molecular heparin may 
      be preferred over unfractionated heparin in the setting of PPCI. Recent data 
      suggest that anticoagulation with bivalirudin can be utilized as an alternative 
      strategy to heparin and Gp2b3a but this should be limited to patients at high 
      risk of bleeding. Dual antiplatelet therapy comprising aspirin and P2Y12 
      inhibitor represents the cornerstone treatment for STEMI. New P2Y12 inhibitors 
      (prasugrel and ticagrelor) have restricted clopidogrel use to situations where 
      these potent agents are contraindicated. Whilst all oral antiplatelet agents have 
      been used with an initial loading dose in STEMI, the time of their administration 
      remains a controversial issue. In everyday practice, intravenous antiplatelet 
      agents appear less consensual. While Gp2b3a receptor inhibitors use has been 
      restricted to bailout situations, the place of cangrelor is not yet defined in 
      real life daily practice.
FAU - Deharo, Pierre
AU  - Deharo P
AD  - Department of Cardiology, CHU Timone, Marseille, France - 
      thomas.cuisset@ap-hm.fr.
FAU - Rahbi, Hazim
AU  - Rahbi H
FAU - Cuisset, Thomas
AU  - Cuisset T
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20160302
PL  - Italy
TA  - Minerva Cardioangiol
JT  - Minerva cardioangiologica
JID - 0400725
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Child
MH  - Fibrinolytic Agents/administration & dosage/*therapeutic use
MH  - Humans
MH  - Percutaneous Coronary Intervention/*methods
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - ST Elevation Myocardial Infarction/*drug therapy/*surgery
EDAT- 2016/03/05 06:00
MHDA- 2017/05/26 06:00
CRDT- 2016/03/03 06:00
PHST- 2016/03/03 06:00 [entrez]
PHST- 2016/03/05 06:00 [pubmed]
PHST- 2017/05/26 06:00 [medline]
AID - R05Y9999N00A16030205 [pii]
PST - ppublish
SO  - Minerva Cardioangiol. 2016 Jun;64(3):238-55. Epub 2016 Mar 2.