{"id":"4cb4df46cd49","type":"article","url":"https://hartvaat.nl/2024/04/16/postprocedurale-anticoagulatie-na-primaire-pci-voor-stemi-multicenter-studie/","title":"Postprocedurale anticoagulatie na primaire PCI voor STEMI: multicenter studie","title_en":"Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulantia","rivaroxaban"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.067079","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.067079","authors":["Yan Yan","Jincheng Guo","Xiao Wang","Guozhong Wang","Zeyuan Fan","Delu Yin","Zhifang Wang","Fuchun Zhang","Changming Tian","Wei Gong","Jiamin Liu","Jiapeng Lu","Yongjun Li","Changsheng Ma","Eric Vicaut","Gilles Montalescot","Shaoping Nie"],"significance":6,"published":"2024-04-16","source_date":"2024-04-16","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This study showed that routine post-procedural anticoagulation after primary PCI for STEMI does not reduce ischemic events but increases bleeding, arguing against this common practice.","created":"2026-07-03T10:30:52Z","updated":"2026-07-03T13:29:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de noodzaak van postprocedurale anticoagulatie na primaire PCI voor STEMI. Routinematige anticoagulatie bood geen voordeel boven standaard antiplaatjestherapie, wat de behandeling kan vereenvoudigen.","abstract_original":"BACKGROUND: Postprocedural anticoagulation (PPA) is frequently administered after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction, although no conclusive data support this practice. METHODS: The RIGHT trial (Comparison of Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After Primary PCI) was an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted at 53 centers in China. Patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomly assigned by center to receive low-dose PPA or matching placebo for at least 48 hours. Before trial initiation, each center selected 1 of 3 PPA regimens (40 mg of enoxaparin once daily subcutaneously; 10 U·kg·h of unfractionated heparin intravenously, adjusted to maintain activated clotting time between 150 and 220 seconds; or 0.2 mg·kg·h of bivalirudin intravenously). The primary efficacy objective was to demonstrate superiority of PPA to reduce the primary efficacy end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The key secondary objective was to evaluate the effect of each specific anticoagulation regimen (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy end point. The primary safety end point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days. RESULTS: Between January 10, 2019, and September 18, 2021, a total of 2989 patients were randomized. The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63 to 1.57]). The incidence of Bleeding Academic Research Consortium 3 to 5 bleeding did not differ between the PPA and placebo groups (8 [0.5%] vs 11 [0.7%] patients; hazard ratio, 0.74 [95% CI, 0.30 to 1.83]). CONCLUSIONS: Routine PPA after primary percutaneous coronary intervention was safe but did not reduce 30-day ischemic events. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03664180."}