In this post, I link to Journal Jam 16 Heparin for ACS and STEMI, [Link is to the podcast and show notes] from Emergency Medicine Cases, January 2020.
Here is the introduction to this excellent resource:
Where I work, when a 60 year old man rolls into the resuscitation room with crushing chest pain and diaphoresis and I get handed the EMS ECG showing an obvious anterior STEMI, it’s kind of a no-brainer: Call a “Code STEMI” and tick off a bunch of boxes so that the nurses can go ahead a give a bunch of meds before the patient is whisked off to the cath lab. On that tick box list is ASA, with a NNT of 42 to prevent death . Next on the list is heparin. I’ve been ticking that box for just about every patient with a STEMI, but now that I’ve reviewed the literature, I’m not so sure I should always be ticking that box – especially in the patient with more than a zero HAS-BLED score. What about NSTEMI or unstable angina? Does heparin – LMWH or unfractionated heparin – benefit the patient with, say, a pretty good story for angina with a bump in their troponin and some ST depression in the lateral leads? I think we’re expected to routinely give heparin for all these NSTEMI and unstable angina patients with any ischemic changes seen on the ECG, right? But should we?….
The podcast and show notes are worth reviewing more than once. Both are outstanding.