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Review
. 2018 Jun;26(6):296-310.
doi: 10.1007/s12471-018-1112-6.

Optimal pharmacological therapy in ST-elevation myocardial infarction-a review : A review of antithrombotic therapies in STEMI

R S Hermanides  1 , S Kilic  1 , A W J van 't Hof  2   3
Affiliations
Review

Optimal pharmacological therapy in ST-elevation myocardial infarction-a review : A review of antithrombotic therapies in STEMI

R S Hermanides et al. Neth Heart J. 2018 Jun.

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.

Keywords: Antithrombotic therapy; STEMI.

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Conflict of interest statement

R.S. Hermanides, S. Kilic and A.W.J. van’t Hof declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mechanism of thrombus formation during STEMI, and targets of available antithrombotic agents. After plaque rupture, a complex mechanism of thrombus formation is mediated. COX cyclooxygenase, TP thromboxane prostanoid, STEMI ST-elevation myocardial infarction
Fig. 2
Fig. 2
Antiplatelet therapy outcomes in major trials. CABG coronary artery bypass grafting, TIMI thrombolysis in myocardial infarction
Fig. 3
Fig. 3
Proposed algorithms for the choice of antithrombotic therapy in STEMI patients undergoing primary PCI. STEMI ST-elevation myocardial infarction, PPCI primary percutaneous coronary intervention, UFH unfractionated heparin, PCI percutaneous coronary intervention, LD low dose, DAPT dual antiplatelet therapy, GPI glycoprotein IIb/IIIa inhibitor
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