Heparin as an adjuvant to thrombolytic therapy in acute myocardial infarction

Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie
B K Metz, E J Topol

Abstract

For the treatment of acute myocardial infarction, heparin has been a topic of continuing debate for the past four decades. After review of the available data, the American College of Cardiology/American Heart Association Guidelines for the Early Management of Patients with Acute Myocardial Infarction, published in 1990, recommended intravenous heparin administration together or immediately after thrombolytic therapy to maintain the activated partial thromboplastin time approximately 1.5 to 2.0 times the control value for 24 to 72 hours. Over the past five years, with the proven benefits or thrombolytic therapy and antiplatelet therapy, investigators have been in search of the ideal thrombolytic agent as well as the best adjunctive antithrombotic strategy. We review a number of angiographic patency trials as well as the major thrombolytic mortality reduction trials in which adjunctive heparin therapy was directly assessed. These trials established the need for intravenous heparin administration with tissue plasminogen activator, but, on the other hand, do not substantiate the need for either subcutaneous or intravenous heparin use with streptokinase. New data from a large scale trial emphasizes the importance of maintaining the ...Continue Reading

References

Nov 17, 1977·The New England Journal of Medicine·T C ChalmersA M Kunzler
Oct 14, 1988·JAMA : the Journal of the American Medical Association·S YusufL Friedman
Jun 1, 1981·Scandinavian Journal of Clinical and Laboratory Investigation·F K Rømer, H J Kornerup
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Sep 2, 1993·The New England Journal of Medicine·UNKNOWN GUSTO investigators
Jul 1, 1995·European Heart Journal·C H HennekensP M Ridker

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Citations

Mar 6, 2004·Journal of Thrombosis and Haemostasis : JTH·H C KwaanI Weiss
Mar 22, 2000·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·O IqbalW Wehrmacher

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