Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction? Insights from the HORIZONS-AMI trial
Research article published in European heart journal. Acute cardiovascular care (2015)
Abstract
AIM: Post-procedural anticoagulation (AC) for routine prophylaxis may be administered after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI), but the risks and benefits of this practice are uncertain. We therefore sought to assess the utility of routine post-procedural AC after primary PCI. METHODS AND RESULTS: Patients undergoing primary PCI in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were grouped according to whether they received post-PCI AC for routine prophylaxis. Outcomes were assessed using propensity-adjusted multivariable analysis. Among 2932 patients in whom primary PCI for STEMI was performed, 869 (29.6%) received post-PCI AC for routine prophylaxis (median duration four days) and 2063 (70.4%) received no post-PCI AC. Time from PCI to ambulation was similar in both groups (median 0.9 vs 1.0 days, p=0.40), although hospitalization was prolonged in patients receiving AC for routine prophylaxis (median 6.0 vs 4.0 days, p<0.0001). After propensity-adjustment, patients who received and did not receive AC for routine prophylaxis after PCI experienced similar rates of 30-day adverse ischemic and major bleeding events. Deep venous thrombosis or pulmonary emboli developed rarely (0.3%) within 30 days, and were not significantly reduced by use of post-PCI AC for routine prophylaxis. CONCLUSIONS: In this large-scale prospective study, use of post-procedural AC for routine prophylaxis was relatively common, and was not associated with improved clinical outcomes, although the duration of hospitalization was prolonged. These data suggest that post-PCI AC for routine prophylaxis may not provide benefit after successful primary PCI in patients in whom early ambulation is likely.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction? Insights from the HORIZONS-AMI trial.
Warum dies für die Hirudotherapie relevant ist
Diese Studie untersuchte den Nutzen einer routinemäßigen postinterventionellen Antikoagulation zur Prophylaxe nach primärer perkutaner Koronarintervention bei Patienten mit ST-Hebungs-Myokardinfarkt (STEMI) mittels eines propensity-adjustierten multivariablen Vergleichs innerhalb der Studienpopulation der HORIZONS-AMI-Studie. Die Autoren berichten, dass die routinemäßige postinterventionelle Antikoagulation nicht mit verbesserten klinischen Ergebnissen assoziiert war, einschließlich unerwünschter ischämischer Ereignisse, schwerer Blutungen oder tiefer Venenthrombose/Lungenembolie, während die Dauer des Krankenhausaufenthalts verlängert war. Das Thema der systemischen Antikoagulation ist pharmakologisch benachbart zum Blutegel-Sekretom, aber die Studie bewertet standardmäßige kardiovaskuläre Pharmakotherapien und keine aus Blutegeln gewonnenen Substanzen. Daher hat diese Arbeit keine direkte Relevanz für die Hirudotherapie oder das Blutegel-Sekretom.
Zitation
Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction? Insights from the HORIZONS-AMI trial
Madhavan MV et al. · European heart journal. Acute cardiovascular care, 2015
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