Long-Term Anticoagulation with Heparin in Patients Receiving Fibrinolytic Therapy for AMI

Kakhi Paposhvili, Medea Shushania, Arsen Kvitsiani, 
Zaza Chapichadze

Background: The fibrinolytic therapy for acute myocardial infarction fails to achieve reperfusion in 40-70% of patients. We did a trial to compare the 48 and 96 h heparin administration in patients undergoing fibrinolysis by streptokinase for acute myocardial infarction. Methods: 99 patients with acute ST-elevation myocardial infarction were randomly assigned an intravenous 48-h infusion of heparin (n=53) or 96 h (n=46) administration together with a standard 1,5 million unit dose of streptokinase). The primary endpoint was 30-day mortality and re-infarction during 96 h of hospitalization. Findings By 30 days, 5 patients (9,4%) in 48 h heparin group and 4 patients (8,7%) in the 96 h heparin group had died. There were significantly fewer reinfarctions in patients of 96 h heparin group than in 48 h heparin group (t<0,05). Conclusions: Long-term 96 h heparin anticoagulation combined with streptokinase infusion reduced MI mortality by 7,4% in compare with short term 48 h heparin administration and reduced the rate of reinfarction during hospitalization by 18,4%.

Keywords:   heparin, anticoagulation, fibrinolysis, myocardial infarction