Antithrombotic Selection in ST-Segment Elevation Myocardial Infarction: a Year in Review

In ST-segment elevation myocardial infarction (STEMI), interventional cardiologists must move quickly to safely re-establish blood flow while choosing an antithrombotic to preclude wire thrombosis, aid in the restoration of flow, minimize thrombus propagation, and reduce the risk of stent thrombosis. Currently, operators have a choice between heparin and bivalirudin with the possible addition of glycoprotein IIb/IIIa inhibitors (GPIs). Prior studies have shown that bivalirudin use lowers rates of bleeding, but with a clear risk of acute stent thrombosis. Recent studies have examined this question in the modern era of radial access and newer antiplatelet agents. Despite these studies, there remains a question regarding which antithrombotic agent is to be selected in STEMI.