Anticoagulation Therapy In STEMI Patients During Primary PCI

Coronary heart disease (CHD) is the one of leading causes of death in the world. The main mechanism is myocardial ischemia and hypoxia that caused by coronary atherosclerosis luminal stenosis or obstruction. And acute coronary syndrome (ACS) is an acute clinical type of CHD. On the basis of coronary atherosclerosis, when atheromatous plaque crack or break it expose the material that will lead to thrombosis to the bloodstream. Therefore it causes platelet adhesion to form the thrombus, resulting in lesions’vessels complete or incomplete occlusion. So the key treatment of ACS lies in antithrombotic therapy. For patients with ST-segment elevation myocardial infarction (STEMI), standard treatment is intended to quickly reopen the blocked artery. According to the guidelines the use of primary percutaneous coronary intervention (PPCI) is recommended for patients with STEMI who have an onset of symptoms of less than 12 hours within 90-120 minutes. Severe bleeding events are associated with the prognosis in ACS patients after PCI. Therefore, reducing bleeding complications is as important as preventing ischemic events. A large number of clinical trials have proved that bivalirudin (as a direct thrombin inhibitor) can not only reduce ischemic events but also reduce bleeding events, especially for NSTEACS (non ST segment elevation acute coronary syndrome) patients. This advantage has been widely recognized. But for the acute ST segment elevation myocardial infarction (STEMI) patients who will accept primary PCI, it remains to be a hot topic that whether heparin or bivalirudin is better for anticoagulation. This paper is aimed at summarizing the main research progress on the treatment strategy of primary PCI in STEMI patients with anticoagulation. By combining with the current actual situation in China, finally we wish to provide some feasible suggestions for anticoagulation treatment.