Early Treatment of ST-segment-elevation Myocardial Infarction Incorporating Results of the FINESSE Trial

2009 ◽  
Vol 5 (1) ◽  
pp. 85 ◽  
Author(s):  
Luc Janssens ◽  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Clinical Benefit ◽  
Bleeding Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

A significant mortality reduction has been observed in the last few decades in the treatment of ST-segment-elevation myocardial infarction (STEMI), mainly due to pharmacological and/or mechanical reperfusion therapies. Primary angioplasty has provided further survival benefits compared with thrombolysis. Treatment delays are still common for patients with STEMI who are referred for primary percutaneous coronary intervention (PCI), and have led to clinical trials evaluating the possible clinical benefit of ‘facilitated’ PCI. Clinical trials – principally Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) – were not able to demonstrate a net clinical benefit of pre-PCI pharmacological reperfusion with thrombolytics, glycoprotein IIb/IIIa inhibitors or a combination of both therapies. At the same time, the data suggest further study may be needed in certain high-risk groups to address the need to find therapies that improve reperfusion without greatly increasing bleeding risk.

Anticoagulation in the Management of ST-Segment Elevation Myocardial Infarction

2010 ◽  
Vol 23 (4) ◽  
pp. 335-343
Author(s):  
Paul P. Dobesh ◽  
Toby C. Trujillo
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Anticoagulant Therapy ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Detailed Examination ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Reperfusion Strategy

Patients with ST-segment elevation myocardial infarction (STEMI) require immediate reperfusion therapy in order to salvage ischemic myocardial tissue and reduce mortality. Reperfusion therapy can be provided mechanically with primary percutaneous coronary intervention (PCI), or pharmacologically with fibrinolysis. Regardless of the reperfusion strategy selected, the appropriate use of anticoagulant therapy is critical to its success. There have been a number of clinical trials evaluating the different anticoagulants in patients with STEMI, as well as recent updates to the guidelines for management of patients with STEMI and on the use of PCI. When making clinical decisions on the use of anticoagulant therapy in the management of patients with STEMI, it is important to not only understand the contents of these consensus guidelines but to also have an appreciation of the details of the clinical trials that have evaluated the different anticoagulants. In this review, the reader will find an evaluation of the current guidelines concerning the use of anticoagulant therapy in patients with STEMI as well as a detailed examination of the literature with critical analysis on issues that should be considered when deciding on the appropriate implementation of anticoagulant therapy in patients with STEMI undergoing either mechanical or pharmacologic reperfusion.

scholarly journals Acute Serious Thrombocytopenia Associated with Intracoronary Tirofiban Use for Primary Angioplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mustafa Yurtdaş ◽  
Yalin Tolga Yaylali ◽  
Nesim Aladağ ◽  
Mahmut Özdemir ◽  
Memiş Hilmi Atay
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Successful Management ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Tirofiban, a specific glycoprotein IIb/IIIa inhibitor, may cause extensive thrombocytopenia with an incidence of 0.2% to 0.5%. We report the case of a 50-year-old man who developed thrombocytopenia after tirofiban use (both intracoronary and peripheral) over hours and the successful management of this complication after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

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