Anticoagulation with medical
or thrombolytic therapy
Among patients receiving conservative treatment
or fibrinolytics, all agents can be used except for
bivalirudin, which has not been well studied in
these settings (Table 233–38
). Both enoxaparin (relative
risk [RR] 0.83, 95% CI 0.77–0.90) and fondaparinux
(RR 0.82, 95% CI 0.66–1.02) when used
up to 8 days or until discharge were found to
reduce major cardiac events in ST elevation MI
compared with unfractionated heparin.
33,35 An increase
in major bleeding was present with enoxaparin
(RR 1.53, 95% CI 1.23–1.89).
33 Head-tohead
comparison of enoxaparin and fondaparinux
was done in non–ST elevation acute coronary syndrome
and showed that fondaparinux caused fewer