Prehospital unfractionated heparin prior to primary PCI

Introduction: Unfractionated heparin is an anticoagulant used by some, but not all, ambulance services in the treatment of patients who will undergo primary percutaneous coronary intervention (PPCI) due to ST-elevation myocardial infarction (STEMI). Aims: The purpose of this study is to review the effectiveness and safety of prehospital unfractionated heparin administration to STEMI patients prior to PPCI, and to consider whether this drug should be more widely used for these purposes across international ambulance services. Methods: A literature search was conducted to identify articles relevant to prehospital unfractionated heparin (UFH) administration prior to PPCI. Eighteen journal articles and ten clinical practice guideline compendiums from international ambulance services were selected for this review. Results: The reviewed literature unequivocally demonstrates that early anticoagulant administration is safe, effective and highly appropriate for STEMI patients who subsequently undergo PPCI. There are disagreements, however, about whether UFH is the more optimal anticoagulant when compared with enoxaparin. Conclusion: This study finds that anticoagulants—such as unfractionated heparin or, in some jurisdictions, enoxaparin—should be strongly considered as a standard feature of prehospital treatment regimens for STEMI patients who will subsequently undergo PPCI.

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