In this episode, I’ll discuss using a heparin bolus in the prehospital setting for patients with STEMI.
Back in episode 1124, I discussed a study on the use of peripheral vasopressors in the prehospital setting that found they were feasible and safe with no peripheral tissue damage. While the patients in this study were under the care of lifeflight medicine providers, EMS providers that transport patients via ambulance would also find use in a study that supports peripheral vasopressor use in the prehospital setting.
Another group of authors recently published a randomized trial looking at Prehospital Heparin Administration in Patients With STEMI Undergoing Primary PCI.
In this open label single center trial just under 600 patients with STEMI with under 6 hours symptom duration were assigned 1:1 to receive either a 70 to 100 units/kg bolus of UFH at first prehospital medical contact plus a supplemental dose before PCI, adjusted to activated clothing time above 250 seconds, or to a control group receiving standard UFH at the time of PCI.
Efficacy and safety was analyzed using TIMI flow in the infarct-related artery at initial coronary angiography and significant bleeding during the hospital stay.
The heparin group achieved a TIMI grade 2-3 flow in the infarct-related artery in 43% of patients vs just 27% in the control group. This represents a relative risk of 1.59 in favor of prehospital treatment with heparin.
For the safety analysis, a Bleeding Academic Research Consortium score of 3-5 was considered, which represents major bleeding episodes. Bleeding rates were 2.4% and 2% in the heparin and control groups, respectively, a difference that was not statistically significant.
The authors concluded:
In patients with STEMI undergoing primary PCI, in a mature STEMI network, pretreatment with UFH at first prehospital medical contact was associated with an absolute 16% increase in infarct-related artery patency without an increased risk of bleeding.
Pharmacists can play a key role in expanding the prehospital use of critical medications in line with available evidence, but will need to take proactive steps to be involved in the process. Seek out your local EMS medical committee and see if you can participate, and familiarize yourself with national EMS medication guidelines as well as your local ones.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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