Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomized trials in the era of stents and P2Y12 inhibitors

. 2014 Nov 11;349:g6419. doi: 10.1136/bmj.g6419

Evidence based considerations for anticoagulant choice during primary percutaneous coronary intervention for patients with ST segment elevation myocardial infarction

Anticoagulant	2013 ACC-AHA guidelines	2014 ESC guidelines	Ranking for efficacy or safety		Considerations for current practice
Anticoagulant	2013 ACC-AHA guidelines	2014 ESC guidelines	MACE	Major bleeding	Considerations for current practice
Unfractionated heparin + GPI	COR I	COR I	2nd	4th	Likely worse bleeding with newer P2Y₁₂ inhibitors Bleeding risk somewhat mitigated with transradial procedure
LMWH + GPI	None	COR IIa	1st	3rd	Likely worse bleeding with newer P2Y₁₂ inhibitors Bleeding risk somewhat mitigated with transradial procedure
Unfractionated heparin	COR I	COR I	4th	2nd	Likely improved MACE with newer P2Y₁₂ inhibitors but may negate bleeding advantage
Bivalirudin	COR I Preferred over unfractionated heparin + GPI in those at high risk of bleeding (COR IIa)	COR IIa	3rd	1st	Likely improved MACE with newer P2Y₁₂ inhibitors but may negate bleeding advantage
Fondaparinux	COR III	COR III	5th	5th	Should not be recommended based on current data

ACC-AHA = American College of Cardiology Foundation and American Heart Association. ESC = European Society of Cardiology. MACE = major adverse cardiovascular event. COR = class of recommendation. GPI= glycoprotein IIb/IIIa inhibitor. LMWH= low molecular weight heparin.