18 Sept 2023 • In the first randomized trial assessing postprocedural anticoagulation(PPA) in patients undergoing primary PCI for STEMI, known as the RIGHT trial, researchers found that PPA did not confer significant benefits or harm compared to a placebo. The study, presented at the European Society of Cardiology (ESC) Congress 2023, involved 2,856 STEMI patients who were randomized to receive PPA or a placebo.

• The PPA group received one of three low-dose anticoagulation regimens over 48 hours or until discharge (0.2 mg/kg per hour of bivalirudin administered intravenously; 40 mg of enoxaparin administered subcutaneously, or 10 U/kg per hour of unfractionated heparin (UFH) to maintain an activated coagulation time between 150 and 200 seconds), while all patients received bivalirudin anticoagulation during PCI.
• The primary endpoint, which included all-cause death, non-fatal MI, non-fatal stroke, stent thrombosis, or urgent revascularization at 30 days, showed no significant difference between the PPA and placebo groups.
• Additionally, there were no significant variations in secondary ischemic endpoints or bleeding risks between the two groups.

While some differences were observed among the three anticoagulant regimens, the study suggested that larger trials are needed to explore these potential distinctions. Further research is necessary to reevaluate the potential benefits of PPA after STEMI, emphasizing the need for additional trials to determine the optimal PPA strategy for reducing early ischemic events following PCI.

Source: ACC | Read full story