Optimal pharmacological therapy in ST-elevation myocardial infarction-a review

R. S. Hermanides, S. Kilic, A. W. J. van't Hof*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

7 Citations (Web of Science)

Abstract

Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications. Compared with clopidogrel, prasugrel and ticagrelor are more potent and predictable, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in primary percutaneous coronary intervention. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. In this review, we provide a critical and updated review of currently available antithrombotic therapies used in patients with STEMI undergoing primary PCI. Finding a balance that minimises both thrombotic and bleeding risk is difficult, but crucial. Further randomised trials for this optimal balance are needed.
Original languageEnglish
Pages (from-to)296-310
Number of pages15
JournalNetherlands Heart Journal
Volume26
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Keywords

  • STEMI
  • Antithrombotic therapy
  • PERCUTANEOUS CORONARY INTERVENTION
  • RANDOMIZED CONTROLLED-TRIAL
  • GLYCOPROTEIN IIB/IIIA INHIBITOR
  • ASSOCIATION TASK-FORCE
  • HIGH-DOSE TIROFIBAN
  • SEGMENT ELEVATION
  • PRIMARY PCI
  • PREHOSPITAL INITIATION
  • PRACTICE GUIDELINES
  • AMERICAN-COLLEGE

Cite this