Choice of anticoagulant in patients with STEMI by reperfusion strategy

eGFR: estimated glomerular filtration rate; IV: intravenous; PCI: percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction; UFH: unfractionated heparin.

* For further information on choosing a reperfusion strategy, refer to UpToDate content on reperfusion in STEMI.

¶ In patients with prior history of heparin-induced thrombocytopenia, bivalirudin is the anticoagulant of choice.

Δ For additional details on the differences between UFH and bivalirudin, refer to UpToDate content on anticoagulation in patients with STEMI. In patients treated with bivalirudin, the infusion should continue after PCI at 1.75 mg/kg/hour (1 mg/kg/hour for eGFR <30 mL/min/1.73 m²) for 2 to 4 hours.

◊ Refer to UpToDate content on selecting a reperfusion strategy for more information on the approach to PCI after primary fibrinolysis.

§ Fondaparinux may not be available for this use in some regions (eg, IV administration dose not have regulatory approval in the United States).