ABSTRACT

INTRODUCTION Primary angioplasty has improved survival benefits as compared to thrombolysis in the treatment of ST-segment elevation myocardial infarction (STEMI) (1). Since the first angioplasty performed by Andreas Gruntzig in the late 1970s, unfractionated heparin (UFH) has been the anticoagulation therapy of choice also in primary angioplasty. It has been shown that very high dose (20,000 Units) is associated with increased risk of bleeding complications (2). A retrospective analysis from the Zwolle group has shown that early preprocedural heparin administration is associated with increased rates of preprocedural recanalization as compared to periprocedural administration (3), and therefore should be considered as part of a facilitation strategy. What is currently recommended is an early (Ambulance or CCU) heparin administration (60 Units/kg) and additional periprocedural bolus (60 Units/kg). The use of protamine (1 mg/100 Units of heparin) should be administrated if it is necessary to antagonize and revert the effects of heparin in case of periprocedural complications. However, despite successful mechanical revascularization, suboptimal reperfusion may occur in a relatively large proportion of patients, resulting in an unfavorable outcome (4-7). Thus, great efforts have been made in the past years to improve anticoagulation therapies as an essential complement to mechanical reperfusion.