An update on the use of anticoagulant therapy in ST-segment elevation myocardial infarction

M. van Gameren; M. E. Lemmert; J. M. Wilschut; J. Daemen; P. P. T. De Jaegere; F. Zijlstra; N. M. D. A. Van Mieghem; R. Diletti

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An update on the use of anticoagulant therapy in ST-segment elevation myocardial infarction

机译：抗凝血治疗在ST段抬高心肌梗死中的使用更新

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Introduction: Together with antiplatelet therapy, anticoagulants are vital to improve outcomes in patients presenting with ST-segment elevation myocardial infarction. Challenges lie in finding the optimal balance between the risk of bleeding and preventing thrombotic complications such as reinfarction or stent thrombosis. During the last decade, bivalirudin was introduced as a valid alternative to heparin for patients undergoing primary percutaneous coronary intervention. Several trials have been conducted to identify the agent with the best antithrombotic results at the lowest bleeding complication rate. In a rapidly evolving field with changes in vascular access, available P2Y12 inhibitors, and indications for glycoprotein Mb/MIa inhibitor administration, conflicting evidence became available. Areas covered: This paper mainly focuses on the evidence above and gives brief discussion to the recent literature on anticoagulation in fibrinolytic therapy and advances in antiplatelet therapy. Expert opinion: To date, no robust evidence is available challenging unfractionated heparin as the primary choice for anticoagulation in patients presenting with ST-segment elevation myocardial infarction. Further research should include efforts to refine anticoagulation strategies on an individual patient level. For patients undergoing primary percutaneous coronary intervention, bivalirudin could be used as an alternative to unfractionated heparin, while enoxaparin or fondaparinux is an alternative agent for patients treated with fibrinolytic therapy.

机译：简介：与抗血小板治疗一起，抗凝血剂对患有ST段抬高心肌梗死的患者改善结果至关重要。挑战谎称在出血风险与预防血栓形成或支架血栓形成等血栓形成之间的最佳平衡方面。在过去十年中，Bivalirudin被引入肝素的有效替代方案，用于接受初前经皮冠状动脉介入的患者。已经进行了几种试验以以最低出血并发症率的最佳抗血栓形成结果鉴定药剂。在血管接入的变化的快速发展现场中，可用的P2Y12抑制剂和糖蛋白MB / MIA抑制剂给药的适应症，可获得相互矛盾的证据。所涵盖的领域：本文主要侧重于上述证据，并介绍近期抗凝纤维蛋白溶解治疗和抗血小板治疗进程的文献。专家意见：迄今为止，没有稳健的证据可挑战未分支的肝素作为患有ST段抬高心肌梗死的患者抗凝的主要选择。进一步的研究应包括在各个患者水平上改进抗凝策略的努力。对于接受初级经皮冠状动脉干预的患者，Bivalirudin可以用作未分叉的肝素的替代品，而烯脱蒿素或Fordaparinux是用纤维蛋白溶解治疗治疗的患者的替代剂。

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《Expert opinion on pharmacotherapy》 |2018年第18期|共10页
作者
M. van Gameren; M. E. Lemmert; J. M. Wilschut; J. Daemen; P. P. T. De Jaegere; F. Zijlstra; N. M. D. A. Van Mieghem; R. Diletti;
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Department of Cardiology Thoraxcenter Erasmus University Medical Center Rotterdam The;

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正文语种 eng
中图分类药学;
关键词
Anticoagulation; ST-elevation myocardial infarction; heparin; bivalirudin; primary percutaneous coronary intervention;

机译：抗凝;st-expation心肌梗死;肝素;Bivalirudin;初生经皮冠状动脉介入;

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1. An update on the use of anticoagulant therapy in ST-segment elevation myocardial infarction [J] . M. van Gameren, M. E. Lemmert, J. M. Wilschut, Expert opinion on pharmacotherapy . 2018,第13a18期

机译：抗凝血治疗在ST段抬高心肌梗死中的使用更新
2. Oral antiplatelet therapy in unstable anginaon-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infarction, and percutaneous coronary intervention: is it time for a guideline update? [J] . Saucedo JF The American Journal of Cardiology . 2009,第5Suppla期

机译：不稳定型心绞痛/非ST段抬高型心肌梗塞，ST段抬高型心肌梗塞和经皮冠状动脉介入治疗的口服抗血小板治疗：是否该进行指南更新？
3. Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network registry. [J] . Fox CS, Muntner P, Chen A Circulation: An Official Journal of the American Heart Association . 2010,第3期

机译：慢性肾脏病患者ST段抬高型心肌梗塞和非ST段抬高型心肌梗塞的近期预后中采用循证疗法：国家心血管数据急性冠脉治疗和干预结果网络注册中心的报告。
4. The Discovery of Prognosis Factors Using Association Rule Mining in Acute Myocardial Infarction with ST-Segment Elevation [C] . Kwang Sun Ryu, Hyun Woo Park, Soo Ho Park, International conference on information technology in bio- and medical informatics . 2015

机译：关联规则挖掘在急性ST段抬高心肌梗死中的预后因素发现
5. The prognosis and outcomes of patients with a ST-segment elevation myocardial infarction and the biochemical and clinical inflammatory response [D] . van Diepen, Sean frederick 2013

机译：ST段升高心肌梗死患者的预后和结果及生物化学和临床炎症反应
6. Shock Index-C: An Updated and Simple Risk-Stratifying Tool in ST-Segment Elevation Myocardial Infarction [O] . Peng Ran, Xue-biao Wei, Ying-wen Lin, 2021

机译：SHOCK INDEX-C：ST段抬高心肌梗死中的更新和简单的风险分层工具
7. MODERATED EPOSTERS1385Longitudinal strain assessment in dilated cardiomyopathy patients using a novel accelerated DENSE sequence1407Simultaneous T1 and T2 cardiac quantification with CABIRIA: initial clinical experience1423Head-to-head comparison of acceleration algorithms in 4-dimensional flow CMR1502Left ventricular function and size evaluated by hybrid cardiac positron emission tomography-magnetic resonance: Intraindividual comparison of left ventricular ejection fraction and ventricular volumes derived by two modalities1510Left Atrium assessed by Cardiovascular Magnetic Resonance at 1.5 and 3 Tesla – age and gender effects1514Comparison of Free Breathing Cardiac MRI Radial technique to the Standard Multi breath-hold cine SSFP CMR technique for the assessment of LV Volumes and Function1536Self-navigated free-breathing isotropic 3D whole heart phase sensitive inversion recovery magnetic resonance without navigator for detection of myocardial infarction1547Assessment of Right Ventricular Strain Using Myocardial Deformation Recovery Semi Automated Technique: Initial Experience and Normal Values1586Tissue tracking myocardial deformation analysis and prediction of left ventricular remodeling in acute myocardial infarction1589Investigating strategies for optimal 31P MRS clinical cardiac at 3T: Initial Results1620Quantitative Criteria for the Diagnosis of the Congenital Absence of Pericardium by Cardiac Magnetic Resonance1632Widespread tissue injury during acute myocardial infarction: evidence from advanced CMR relaxometry1322Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)1339Comparison of low- versus high-dose of gadobutrol for late gadolinium enhancement imaging at 1.5 Tesla: a clinical feasibility study1347Multi-parametric Cardiac Magnetic Resonance for Prediction of Cardiac Complications in Thalassemia Intermedia: a Prospective Multicenter Study1461Prognostic value of Cardiovascular Magnetic Resonance derived indexes of myocardial fibrosis in heart transplant recipients1523The role of CMR in the acute phase of hospitalization: changing paradigms1542Preoperative CMR-based score predict ventricular response after surgical left ventricular reconstruction in ischemic heart failure patients1555Excellent response rate to cardiac resynchronization therapy guided with magnetic resonance imaging1626The ECG as a predictor of arrhythmogenic substrate on Cardiac Magnetic Resonance Imaging in patients undergoing ablation for premature ventricular contractions1649Comparison of T1-mapping at 3.0T CMR and angiographic APPROACH score for area at risk assessment in ST-segment elevation myocardial infarction1340Pathological correlates of left bundle branch disease in patients with non-ischemic cardiomyopathy: a cardiovascular magnetic resonance study1342Myocardial remodelling and fibrosis in nonischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance1411The association between fibrosis and contractile dysfunction in hypertrophic cardiomyopathy assessed by cardiovascular magnetic resonance1622Persistent myocardial inflammation due to intramyocardial haemorrhage in reperfused STEMI as a precursor to adverse LV remodelling - insights from multi-parametric mapping1566Semiquantitative analysis of low and high b value DWI for detecting myocardial edema in acute myocarditis1567Value of Cardiac MRI In Detecting Coronary Artery Disease In Newly Diagnosed Systolic Dysfunction1570Usefulness of cardiac magnetic resonance in tuberous sclerosis complex1578Papillary muscles offer further insight into hypertrophied hearts: a cardiovascular magnetic resonance study1627Diagnostic and clinical implications of CMR timing (early versus late) in patients with troponin positive acute coronary syndromes and unobstructed coronary arteries: Table 1. [O] . Upasana Tayal, Alexandros Kallifatidis, P. Garg, 2016

机译：在使用新的扩张型心肌病的患者缓和EPOSTERS1385Longitudinal应变评估加速DENSE sequence1407Simultaneous T1和T2与CABIRIA心脏定量：在4维流动的加速算法初始临床experience1423Head对头比较CMR1502Left心室功能和尺寸由混合心脏正电子发射断层摄影术评价 - 磁性共振：由两个modalities1510Left庭派生左室射血分数和心室体积的个体间的比较，在1.5和3特斯拉评估心血管磁共振 - 免费的年龄和性别effects1514Comparison呼吸心脏MRI径向技术标准的多屏气电影SSFP CMR技术的LV卷和Function1536Self-导航自由呼吸各向同性3D整个心脏相位敏感反转恢复磁共振导航仪没有检测右Ventricu心肌infarction1547Assessment的评估拉尔菌株使用心肌变形恢复半自动技术：初步经验和正常Values1586Tissue跟踪心肌变形分析和预测左室重构急性心肌infarction1589Investigating策略优化31P MRS临床心脏在3T：初始Results1620Quantitative标准的先天缺失的诊断心包心脏磁Resonance1632Widespread组织损伤急性心肌梗死时：证据先进CMR relaxometry1322Computed CT冠状动脉成像与压力心脏磁共振对症的管理吻合血管患者：成本效益研究（战略研究）1339Comparison低与高剂量钆布醇在1.5特斯拉晚钆增强成像的临床可行性，在中间型地贫心脏并发症的预测study1347Multi参数心脏核磁共振的前瞻性德穆尔心血管磁共振的ticenter Study1461Prognostic价值衍生心肌纤维化指标在住院的急性期CMR的心脏移植recipients1523The作用：改变基于CMR-paradigms1542Preoperative比分预测缺血性心脏衰竭patients1555Excellent响应速度外科左心室重建心脏再同步化后心室反应治疗与磁共振imaging1626The ECG导引作为心脏磁共振成像致心律失常性基板的在ST段抬高心肌infarction1340Pathological在风险评估经历在3.0T CMR T1映射的室性早搏contractions1649Comparison和血管造影APPROACH分数区域消融患者的预测左束支传导疾病的患者与非缺血性心肌病相关因素：心血管磁共振study1342Myocardial重塑和纤维化nonischaemic扩张型心肌病：在从在由心血管磁性resonance1622Persistent心肌炎症评估肥厚型心肌病的纤维化和收缩功能障碍之间心血管磁性resonance1411The协会由于心肌内出血景点在再灌注STEMI为先导，以不利的LV重塑 - 从低的多参数mapping1566Semiquantitative分析和高的b值DWI的见解为在心脏MRI检测冠状动脉疾病急性myocarditis1567Value在结节性硬化症complex1578Papillary肌肉初诊收缩期Dysfunction1570Usefulness心脏磁共振检测心肌水肿提供进一步的深入了解肥大心脏：心血管磁共振study1627Diagnostic和CMR定时的临床意义（早期与晚）患者肌钙蛋白阳性的急性冠脉综合征和通畅的冠状动脉：表1。

An update on the use of anticoagulant therapy in ST-segment elevation myocardial infarction

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