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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, January 28, 2020

Heparin for ACS and STEMI

Heparin for ACS and STEMI
Podcast production by Justin Morgenstern, Rory Spiegel and Anton Helman.
Podcast editing and sound design by Katrina D’Amore & Anton Helman. 
Blog summary by Anton Helman, January 2020.
"Where I work, when a 60 year old man rolls into the resuscitation room with crushing chest pain and diaphoresis and I get handed the EMS ECG showing an obvious anterior STEMI, it’s kind of a no-brainer: Call a “Code STEMI” and tick off a bunch of boxes so that the nurses can go ahead a give a bunch of meds before the patient is whisked off to the cath lab. On that tick box list is ASA, with a NNT of 42 to prevent death [1]. Next on the list is heparin. I’ve been ticking that box for just about every patient with a STEMI, but now that I’ve reviewed the literature, I’m not so sure I should always be ticking that box – especially in the patient with more than a zero HAS-BLED score. What about NSTEMI or unstable angina? Does heparin – LMWH or unfractionated heparin – benefit the patient with, say, a pretty good story for angina with a bump in their troponin and some ST depression in the lateral leads? I think we’re expected to routinely give heparin for all these NSTEMI and unstable angina patients with any ischemic changes seen on the ECG, right? But should we?….
Take home message for heparin in ACS and STEMI
Heparin should not be considered as routine therapy for ACS and STEMI. Based on lack of clear benefit in the literature, it is not unreasonable to withhold heparin for both ACS and STEMI patients, especially in patients who are at moderate or high risk for bleeding complications."