Anticoagulation for ST-segment elevation myocardial infarction.

Adjunctive anticoagulant therapy reduces the risk of recurrent infarction and death in patients with STsegment elevation myocardial infarction (STEMI) receiving fibrinolytic therapy.1–5 Unfractionated heparin (UFH), the first anticoagulant evaluated for this indication,1 continues to be used because of its predominantly nonrenal clearance, short half-life, reversibility, and the familiarity of clinicians with the drug. However, the anticoagulant response to UFH is unpredictable, which necessitates coagulation monitoring, and the time to achieve a therapeutic anticoagulant effect can vary from patient to patient. This is problematic because failure to achieve a therapeutic anticoagulant effect with UFH has been associated with an increased risk of recurrent ischemic events.6