From the Research
Discontinuation of Heparin Infusion in STEMI after Stent Placement
- The optimal duration of heparin infusion after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is not well established 1.
- A study found that a routine post-procedure course of unfractionated heparin (UFH) infusion for more than 48 hours was not associated with any significant benefits in patients with STEMI who underwent primary PCI in the era of drug-eluting stents (DES) 1.
- Another study suggested that early administration of heparin leads to a higher rate of reperfusion in the infarct-related artery (IRA) before primary PCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates 2.
- The European Society of Cardiology recommends dual antiplatelet therapy after STEMI, but does not provide specific guidance on the duration of heparin infusion 3.
- A meta-analysis found that bivalirudin with a 2- to 4-hour post-PCI high-dose infusion reduced cardiac mortality and major bleeding without an increase in ischemic events compared with heparin monotherapy with provisional glycoprotein IIb/IIIa inhibitor (GPI) use 4.
Considerations for Discontinuation
- The decision to discontinue heparin infusion should be based on individual patient factors, such as bleeding risk and ischemic risk 3, 1.
- The use of bivalirudin or other anticoagulants may be considered as an alternative to heparin, depending on patient characteristics and institutional protocols 5, 4.
- Further study is warranted to determine the optimal duration and dose of administration of UFH infusion following primary PCI 1.