Does optimal stenting in acute myocardial infarction require continuous heparinization after the procedure?

Background: To restore rapid TIMI III flow in acute myocardial infarction (AMI) stent implantation for thrombotic culprit lesion has been emerging. The aim of the study was to demonstrate safety to avoid heparin administration after optimal stent implantation in low risk AMI patients. Methods: 107 AMI patients who underwent successful stent implantation between 01/97 and 04/99 were compared with 195 patients who received elective stenting for stable angina in the same term. All patients received bolus 10000 U heparin before the procedure. No additional heparin was given to elective patients after completion of the procedure. Post-stent medication consisted of 200mg ticlopidine and 162mg aspirin daily for 30 days. Results: Of 107 AMI patients 85 patients were devoid of heparin administration after the procedure. The reason for heparin continuation in the remaining was IABP installation (12), residual thrombus (4), slow flow (2) and others (4). There was no difference between AMI group and elective group in terms of age, sex, lesion location, stent type, stent size, inflation pressure, and sheath size. As shown in the table there was no adverse outcome in AMI group in the frequency of complications linked to coagulation occurring in 30 days and rates of restenosis and target lesion revascularization (TLR) at 6months. Conclusions: In low risk AMI patients, same as elective stenting, avoidance of heparin continuation after optimal stent implantation may produce no adverse outcome. acute subacute blood Pts closure thrombosis stroke transfusion restenosis TLR AMI n=85 0 1 2 2 28.4% 13.6% no post heparin (0%) (1.2%) (2.4%) (2.4%) Elective n=195 1 3 1 6 33.9% 27.3% stenting (0.5%) (1.5%) (0.5%) (3.1%) p value NS NS NS NS NS p=0.015.