Letter to the editor

DOI: 10.4244/EIJ-D-22-00821

Letter: Pretreatment with unfractioned heparin in patients undergoing primary PCI: a standard of treatment together with DAPT?

Enrico Fabris1, MD, PhD; Arnoud W.J. van ’t Hof2,3,4, MD, PhD

We read with interest the recent study by Emilsson et al1 reporting the clinical effects of pretreatment with unfractionated heparin (UFH) prior to arrival at the coronary catheterisation laboratory (cath lab) in patients undergoing primary percutaneous coronary intervention (pPCI). The authors are to be commended for this large registry study including 41,631 patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). The study showed that pretreatment with UFH, compared with no pretreatment, was associated with a reduction in coronary artery occlusion (11% relative risk reduction) without increasing the risk of major in-hospital bleeding.

This study supports the early use of heparin in patients undergoing pPCI and corroborates, on a large scale, some previous results23. Indeed, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the prehospital (pre-H) use of heparin was an independent predictor of early myocardial reperfusion expressed as complete ST resolution during patient transportation for pPCI2. These results highlight the importance of in-ambulance treatment and the opportunity to improve early perfusion with the implementation of regional protocols which allow the initiation of...

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Volume 18 Number 17
Apr 24, 2023
Volume 18 Number 17
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