A patient arrives directly in the catheterization laboratory for primary angioplasty. They volunteer a previous serious allergic reaction to heparin called ‘HIT’ as you are consenting them.
What would be your anticoagulation strategy?
A. A single administration of unfractionated heparin in this situation should be safeBivalarudin is a direct thrombin inhibitor and a safe alternative in a patient with previous heparin-induced thrombocytopenia (HIT). The Horizons-AMI trial suggested a significant reduction in all-cause mortality and major bleeding compared with the combination of UFH and GP2b/3a in primary angioplasty patients. Fondaparinux is a synthetic inhibitor of factor Xa and has been shown not to be inferior to LMWH in ACS, with halved major bleeding (OASIS-5 trial).