Cardiology>>>>>Ischaemic heart disease
Question 17#

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 safe
B. Avoid all anticoagulants as a precaution and complete the procedure with Gb2b/3a cover
C. Bivalarudin is safe and effective in this situation
D. A single administration of fondaparinux in this situation should be safe and effective
E. There is a risk with all anticoagulants in this situation, and so the balance of benefit is shifted to thrombolysis over primary angioplasty

Correct Answer is C

Comment:

Bivalarudin 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).