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Pre PCI hospital antithrombotic therapy for ST elevation myocardial infarction: striving for consensus

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Abstract

Strong evidence exists in favor of rapid transfer of a patient suffering an ST-elevation myocardial infarction (STEMI) to the nearest hospital with primary percutaneous coronary intervention (PCI) capability, assuming the time from first medical contact to balloon inflation can be achieved in less than 90 min. In many areas, PCI hospitals have successfully collaborated with regional non-PCI hospitals to provide primary PCI for STEMI; however, significant variations exist in how these programs are executed. For example, the pre PCI hospital administration of antithrombotic agents by emergency medical personnel can include aspirin, clopidogrel, unfractionated heparin, low molecular weight heparin, partial or full dose fibrinolytics or combinations thereof. There is little consensus on the optimal cocktail, dose and route of administration. Standardizing the pre PCI antithrombotic regimen across hospital systems may be one approach to improve timely administration of these therapies, and potentially improve STEMI outcomes.

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Acknowledgments

We would like to thank Vicki Carter and Renae Buchheim for their assistance in creating the figure of the regional map of STEMI referral centers that coordinate care with the University of Wisconsin-Madison. No compensation, apart from employment at the University of Wisconsin-Madison Hospitals and Clinics, was provided.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI, 53792, USA

    S. Michael Gharacholou, Brenda J. Larson, Giorgio Gimelli & Amish N. Raval

  2. Division of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA

    Christian C. Zuver & Ryan J. Wubben

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  1. S. Michael Gharacholou
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Correspondence to S. Michael Gharacholou.

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Gharacholou, S.M., Larson, B.J., Zuver, C.C. et al. Pre PCI hospital antithrombotic therapy for ST elevation myocardial infarction: striving for consensus. J Thromb Thrombolysis 34, 20–30 (2012). https://doi.org/10.1007/s11239-012-0744-4

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