Anticoagulation in ST-Elevation Myocardial Infarction.

Intravenous anticoagulation is standard of care in the treatment of ST-elevation myocardial infarction. Primary percutaneous coronary intervention is the most common reperfusion strategy. Four anticoagulant options are available: unfractionated heparin, enoxaparin, fondaparinux, and bivalirudin. This article discusses the mechanism of action and key pharmacodynamic characteristics of these agents. The evolution of outcomes with unfractionated heparin compared with bivalirudin in the changing landscape of contemporary percutaneous coronary intervention is chronicled. Current anticoagulation recommendations from practice guidelines are provided and unresolved issues including treatment of patient subsets such as women and chronic kidney disease are explored.