Table 1.
Pharmacological properties of anticoagulants in STEMI
| UFH | Enoxaparin | Bivalirudin | |
|---|---|---|---|
| Administration route | Intravenous | Intravenous, subcutaneous | Intravenous |
| Factor Xa:IIa inhibition | 1:1 | 3–4:1 | Only IIa |
| Action independent of antithrombin | No | No | Yes |
| Nonspecific binding | Yes | Partial | No |
| Variable PK/PD measures | Yes | Yes (<unfractionated heparin) | No |
| Inhibits fibrin-bound thrombin | No | No | Yes |
| Effect on platelets | Activation | Activation | Inhibition |
| Half-life | ~60 min | 90–120 min | 25 min |
| Risk of HITT | Yes | Yes (<unfractionated heparin) | No |
| Dose in PPCI | 70–100 U/kg bolus without GPIs; 50–70 U/kg bolus with GPIs | 0.5 mg/kg intravenous bolus | 0.75 mg/kg intravenous bolus; 1.75 mg/kg/h infusion |
| Reversal agent | Protamine sulfate | No | No |
STEMI ST-elevation myocardial infarction, HITT heparin induced thrombocytopenia and thrombosis, PPCI primary percutaneous coronary intervention, GPIs glycoprotein IIb/IIIa inhibitors, PK pharmacokinetic, PD pharmacodynamics UFH unfractionated heparin