1050
461818020012657116
INTERVENČNÍ341804001071978123168215263308366420478499
A8628040010752
AKUTNÍ936804001075299157202263284
KARDIOLOGIE12418040010745103150211232295337397456477520
/18078040010732
Interv188480400107196794136163207
Akut2111804001075290139167
Kardiol.2297804001074588114162181229249264
2024;23(1):43-492581804001074487128168183227271293333351365409450477523565
/31918040010732
www.iakardiologie.cz48438040010765133201214233274312354380428447495515563613632675690730769
KAZUISTIKA341200012665137200272306365424456524597
/959200012632
CASE1012200012660131190248
REPORT1282200012662120184260325384
The34136001063071103
role46036001063374105137
of61336001063869
intracoronary6983600106155689125166200238274315357397432468
thrombolysisin118236001063071107147201237278310342375392424441482
thrombus-laden168036001063071106147201237278310338368410450482523
coronary221936001063271107148190229265301
artery:253636001063873105137173209223
a2773360010638
case282736001063274108139
report298236001063366101142178209
tic3406200109305191
plaque44762001095173116167216261
rupture,72462001093079130160210239284302
and104262001094393144
in120262001092171
the128862001093080125
remaining142962001092974149193214263284334384
30%,182962001094692164184
there34076001093080126155201
is56376001092157
plaque64276001095274117168218264
erosion92876001094675125161182231282
(4).12337600109256993110
Disruption136676001095981117146196248278299349399
of178876001094976
the188776001092979125
atherosclerotic34090001094373123169199248284325346392422471501522563
plaque92490001095173117168218264
results120990001092975111160181211248
in147990001092171
the157190001093080126
sub-endothelial171890001093685137167215265340104001095098127175220241261303323
thrombogenic678104001092978106154227277326376420469489529
matrix12211040010974116145173194235
being1470104001095195116164214
exposed1698104001094486136185220264314
to340118001093182
circulating44911800109416495136188211256287310362415
platelets,891118001095276121152199222270302340361
leading1279118001092269115168191243296
to1602118001093081
platelet1711118001095275121152199222269301
adhesion,340132001094395145191227248297348367
aggregation,730132001094394145174220271315344365415466485
and1238132001094393144
white14051320010966117138168213
thrombus1641132001092979109158234286336371
formation.340146001092676106182226255276326377396
The755146001094596141
concomitant915146001094189140181229305326357401451480
release141414600109307597143186222268
of1700146001095076
tissue179514600109305187122172217
factor340160001092671111144193223
from579160001092657106182
the777160001093080126
site91916000109365787132
of1067160001095076
arterial1160160001094373105150180202245267
injury144316000109217193142172217
activates1677160001094384116137181225255299335
the340174001093079124
extrinsic479174001094587119148170219254274314
coagulation809174001094088131181230251294323344393443
cascade,1267174001094084119159203253298316
resulting1599174001092973109157178208228278328
in1942174001092170
the340188001093080126
formation490188001092676106181225255276326376
of890188001095076
thrombin,990188001093080110159235286308358377
which13911880010966117138179228
then1643188001093080126176
converts1843188001094190140340202001094490121155193
fibrinogen559202001092752105136158210261314361413
to998202001093181
fibrin.1106202001092651104135157209229
This1361202001094699121157
process1545202001095283134177223260296
culminates1868202001094192114340216001097597147190220265301
in666216001092171
the763216001093080126
formation914216001092676106182226256277327378
of1317216001094976
a14192160010943
red1487216001093075127
thrombus1640216001092980109159235286336372
composed340230001094089165216267302348400
of757230001094976
more8492300010975125155201
densely1066230001095197147182228250293
packed1376230001095195136178223275
platelets,1667230001095173117146191213259289326346
erythrocytes,340244001094575121154204234284325370403448484504
inflammatory86924400109217198122166241317360390439469515
cells,1410244001094085107128164183
and1618244001094494146
fibrin,1789244001092751102132154204223
which3402580010966116136176226
over581258001094991135165
time761258001093051125170
becomes947258001095096137185260305340
progressively1303258001095180129180209254289324345388432453496
more18142580010975124154198
robust340272001092979131181217247
(5).60727200109257094111
Massive4802860010972117152188209253297
intracoronary803286001092171100130174215263293343393437467512
thrombi1341286001092979109158234286307
are1674286001094373118
associated1817286001094479115165340300001094060102131175225
with580300001096687116165
reperfusion760300001092973123168198226275310330379428
failure120330000109267090111159188232
and1450300001094391142
more16073000010974122152196
unfavorable1818300001094997123166340314001094392122166217239285
clinical64131400109406182132153194238259
outcomes916314001094999130169218293339375
(6–9).1307314001092570118164188205
If1529314001092148
not15933140010950100130
treated1739314001093059104148177222274
thoroughly,340328001093079129159208257308358379422436
intracoronary792328001092171100129173213262291340391434463508
thrombus1316328001093079109158233284334369
can1701328001094084134
cause1850328001094184134340342001093580
distal434342001095071105135178199
and647342001094392142
microvascular804342001097394133162210251294329368417437480508
obstruction,1327342001094999134163192241281312332380430448
which17903420010965114134174222
is340356001092157
known413356001094293143209260
as689356001094479
the784356001093080126
no-reflow9263560010950100130161206233257307373
phenomenon.13153560010951102148198248324370420470521540
The1871356001094596142
no-reflow3403700010950100130161206233258308373
phenomenon7343700010951102148198248324370420470521
can1275370001094084135
occur1430370001094991130180210
in1660370001092171
50%1752370001094692164
of1936370001095076
cases340384001094084120166202
of558384001094976
acute650384001094384134164209
coronary875384001094089119168219263292338
syndrome1229384001093679130182211261336382
(ACS)1627384001092681131176201
with1844384001096788118168
a3403980010944
high410398001095172124175
thrombus611398001093081111161238290341378
load,1015398001092172117169189
resulting1230398001093076113163185215237288340
in1596398001092172
reduced1694398001093076128179221266319
myocardial3404120010977120171214260291344367412435
perfusion8024120010952100132162215252274326379
at1208412001094475
the1310412001093183131
microvascular1468412001097799141172224268314351394446468514545
level,340426001092167110155177195
increased558426001092171112142187231266312364
infarct94542600109217197142171212244
size,121242600109355695140159
and1394426001094393144
higher1561426001095071122172218248
mortality1832426001097512515534044000109307496117147192
(10,551440001092668110129
11).699440001094684103120
Intracoronary480454001092274104134179221271302353405449480526
thrombus1034454001093182112163241293345382
is1443454001092258
defined1529454001095299127151202249303
as1859454001094581
a19684540010944
filling3404680010927507192112162213
defect577468001095297124169211242
with844468001096788118168
decreased1036468001095197138167212256291337388
contrast1449468001094089140169198242277308
density.178146800109519714718220334048200109307589
Quantification4534820010963113156205234255281304344388417437487537
of1014482001095076
intracoronary1113482001092271100129173213261291340390433462507
thrombus1644482001093079108157233284333368
can340496001094084133
be497496001095196
performed617496001095197126155204233308353404
by1045496001095192
angiography1161496001094393143163212263292335385435476
using1661496001094984104153204
the1888496001093079124
TIMI340510001094466137158
thrombus511510001093078107154228278327361
grade.886510001095078121171215232
The1132510001094494138
TIMI1284510001094465137158
thrombus1455510001093078107154228278327361
scale1830510001093575118138182
relies34052400109307596117162198
on5625240010950100
relative68652400109307597140169190233278
estimates988524001094581111132207251280325360
of1372524001095076
the1472524001093180126
size162252400109365795140
of1787524001094976
the1887524001093080125
thrombus340538001093079107156231281331365
and722538001094392143
affected88153800109436998142183214258309
vessels,1206538001094387122157202223257276
using1498538001094984104153203
a17175380010944
scaled1777538001093676119139184235
score340552001093676124153197
of559552001094975
06565520010946
(no724552001092673122
thrombus)868552001093079107156231281331365387
to1277552001093078
513775520010946
(total1445552001092653101130174194
occlusion1661552001095090129149198233253302352
by340566001095191
thrombus)445566001092977105153226276324358380
(12).838566001092666104127142
The994566001094493137
TIMI1145566001094465136157
thrombus1315566001093078106153227276325359
scale1687566001093675117137181
can1882566001094082130
be340580001095196
simplified449580001093656129179200219245267311362
into82558000109216997145
a9845800010943
low1041580001092169134
thrombus1188580001093078107155229279327362
load1563580001092170113163
(grades1740580001092573101144194238273
1–3)340594001094585128149
and502594001094290139
a6535940010943
high709594001094868116164
thrombus885594001092977104151224273321354
load1252594001092168110159
(grades142459400109257299141190233267
4–5)1704594001094591134156
(13).1873594001092565103124139
Current4806080010953101131162208259289
guidelines7946080010951101123175221243265315362398
recommend1218608001093075117167243319365416468
primary1712608001095282104180224254300
PCI3406220010948100121
as484622001094479
the586622001093080126
treatment735622001093059104148178253299349379
of1137622001094976
choice1236622001094090140161202247
for1505622001092777107
STEMI1635622001094490135208230
patients.188862200109519534063600109305299151182220240
Primary607636001094979101178223254301
PCI9356360010949103125
with1086636001096890122173
stent1286636001093668114166197
implantation1509636001092299152175220271302347378400451503
can340650001094186137
restore504650001093076113144194225271
patency802650001095297127173225267313
in1141650001092172
the1240650001093081128
IRA,1394650001092272130152
resulting1572650001093076113163186216238289341
in1940650001092172
a3406640010945
smaller4126640010937114160183205253284
infarct723664001092274102148179221255
area1005664001094576123169
and1201664001094497150
a13786640010945
lower1450664001092274142189221
number16986640010951103181235283314
of340678001095179
acute452678001094588140172219
and704678001094497151
long-term887678001092275128181212244291323402
events,1322678001094692139192223262283
including1638678001092174117140192246269321375
recurrent340692001092975116166196226271321351
infarction71669200109217298142172212244265315366
and1107692001094494145
death1278692001095096140169220
(2).152369200109257094111
However,16606920010958109175220263308338352
until3407060010950100129151172
now,5377060010950101167182
there745706001093080126156201
has971706001095094130
been1126706001095198144195
no13467060010950100
gold-standard14727060010950100122173203239270314365416460489540
therapy340720001093183131163209263307
for679720001092780111
lesions822720001092270108131183236273
with1127720001096892124176
a13357200010945
high1411720001095275128180
thrombus1623720001093183114166245299352390
burden.3407340010951102132183229279299
Several664734001094591134179209253275
mechanical9647340010976122163213257308329370414436
and1425734001094494146
pharmacological15967340010952103146176252296337386340748001092273125147188233255
approaches621748001094497150180231276317368415452
have1099748001095095138184
been1309748001095299146197
proposed1533748001095182133185237273320373
to1932748001093080
reduce340762001093077130181223269
the635762001093182129
thrombus791762001093081112163240293345381
burden11997620010952104134187234285
and1511762001094496148
post-PCI16867620010952104141173199251305326
complications.340776001094089165216238259300344374395445495531550
Platelet214059001436084138174230256314351
Inhibition252059001432589153177243268306331394459
Early228076001094590120142185
administration249176001094496172193244266302333363408438459510561
of307876001094976
dual3180760010951102146167
antiplatelet337376001094495125146198220265295340362408439
therapy214090001093079124153196247288
(DAPT)244490001092584136183229256
can271690001094083133
reduce286490001092974125174214258
the313790001093079124
thrombus327790001092978107156231281331366
burden36589000109511011302140104001095197148
and2314104001094494146
improve2486104001092197149179229273318
clinical283010400109406283134155196241263
outcomes.31181040010950101131172221297344380400
Aspirin3543104001095693145167197219269
can2140118001094187139
be23051180010953100
given2432118001095274119165217
orally2676118001095081127149171216
by2919118001095296
chewing3041118001094193140208231283335
or3403118001095082
intravenously351111800109227310413518022427021401320010951103155192214259
at2426132001094575
an2528132001094597
initial265213200109217395127149194216
dose28951320010952104141189
of3111132001095078
150–3003216132001094790137187234282331
mg35741320010977130
to3731132001093181
inhibit2140146001092273125147199222253
thromboxane2420146001093082112163241294346388433485532
A2-mediated29791460010956105132211258311334378409455509
platelet3514146001095275120151197220267298
activation2140160001094384116137181225255276326376
(Class253416000109257697140176212
I;2763160001092240
LOE28201600010943103148
B).298616000109497390
The3093160001094596142
onset32521600010950100136182212
of3481160001095076
action3575160001094384116137187238
of2140174001095077
aspirin2242174001094480132154183205256
occurs2523174001095092132182212249
within2798174001096789119170191242
30–603065174001094793142192240
minutes3331174001097597147197228273309
and3666174001094494146
persists2140188001095096125160181215245281
for2436188001092675104
the2555188001092978123
lifetime269318800109214167112141162235280
of2988188001094975
the3078188001092978123
platelets.3216188001095071114143186207252282318336
Potent3567188001094895124167217245
P2Y122140202001094893139183223
inhibitors2388202001092171121143194216246295325362
such2775202001093585126176
as2976202001094379
prasugrel3080202001095181125161210261291336358
603463202001094693
mg35822020010975126
or3733202001094979
ticagrelor214021600109305191136186216261283333363
1802525216001094688135
mg26822160010975126
can2829216001094185135
be2986216001095197
selected3105216001093581103149190222267319
if3446216001092147
available,3515216001094386130151172216267214023000109216785
or2248230001094979
clopidogrel2349230001094162112164185237287338368413435
6002806230001094794142
mg29702300010975126
if3119230001092147
more31892300010975125155200
aggressive3412230001094394145174219255291312356400
treatment2140244001093059105148178253299350379
is2543244001092156
contraindicated2623244001094089140169199243264314365387427471501546598
(Class324424400109267697141177212
I;3480244001092140
LOE35432440010943103148
A).371524400109558097
Prasugrel2140258001094978123160210262293339361
and2528258001094495147
ticagrelor270225800109305193138190220267289340371
have3099258001095196139184
a33102580010944
more33802580010976127158204
rapid3610258001093075128150202
onset21402720010951103140188219
of2386272001095179
action,2492272001094487120142194246266
stronger2785272001093769100151204256304335
potency,31472720010952105136183235277324340
and3514272001094496149
are3690272001094576123
superior2140286001093685136183213234284314
to2478286001093079
clopidogrel2581286001094061111163184236286337367412434
in3039286001092171
clinical313428600109406182132153194238260
outcomes.3418286001094999129169218293339375395
Intravenous2140300001092275106137183227273326378430468
P2Y122635300001095097145191233
agents2895300001094598146198229268
(cangrelor)3190300001092766113165218249296319371403428
may36463000010977123166
also214031400109436398147
be2301314001095196
considered2412314001093987136171191241285314358409
in2836314001092069
patients2920314001095093122142187236264300
who32353140010965115163
have3413314001094992133176
never3604314001094994136179208
taken2140328001093074117161211
an2374328001094393
oral2489328001095080124145
P2Y122656328001094893139183223
receptor2901328001093075117161213243292322
inhibitor3245328001092171121143194215246295325
at3592328001094373
the3687328001093080125
time2140342001093051126171
of2327342001095076
PCI24193420010948100121
or2556342001094979
in2651342001092171
those2738342001093080129165211
who29653420010966116166
are3147342001094373118
intubated3281342001092170100149201245274319371
and3668342001094393144
unable2140356001094998141191212257
to2412356001093078
take2505356001092973114158
oral2678356001094978121142
agents2835356001094392137187215251
(Class310235600109257495137172207
IIb;332435600109214293110
LOE34503560010941101145
A)3610356001095479
(2).370435600109256992109
Glycoprotein2280370001096083127168218271302353384430452503
IIb/IIIa281237000109224497128151174196241
(GPI)3082370001092684134155181
inhibitors3291370001092273125147199222253303334371
are3691370001094575121
angiographically2140384001094493144164213264293337388438458498542563583626
proven2790384001095181129172216266
effective3080384001094571100146186218238282326
agents3430384001094393138188217254
for3707384001092776106
dissolving2140398001095069103136184204246266314362
a25153980010943
thrombus2571398001092977104152224274321355
and2939398001094391140
are3092398001094270113
capable3218398001094082131173222242285
of3516398001094974
restoring3603398001092972105134181214041200109295099149
TIMI2310412001094466138159
flow248941200109275099164
by2673412001095293
inhibiting2786412001092170120140190211240260310360
the3166412001093079124
final331041200109264998141162
pathway3492412001095194123172237280320
of2140426001094975
platelet2239426001095172115144187209253283
aggregation2546426001094393143172216267309338359408457
through3027426001093079107156205255305
competition3355426001094189163214259289309339359408458
for2140440001092777107
binding2272440001095273124175197247298
of2595440001095077
GP26964400010960108
IIb/IIIa282944000109224496126148170192236
receptors3089440001093076117162214244294324361
with3474440001096889119170
von3668440001094494145
Willebrand2140454001097697118138183234263306355406
factor2564454001092770110141189218
and2801454001094493143
fibrinogen.2963454001092649100129150199248298343393411
GPIs33934540010958106126160
inhibit3572454001092170120140190211240
platelet2140468001095273116145190211256286
response2450468001093075110161212262297342
to2816468001093079
all291946800109446585
agonists,3028468001094494144194215250280317335
resulting3387468001093075110159180210230280331
in3742468001092171
rapid2140482001093073124145195
and2359482001094493144
almost2527482001094464139189224254
complete2805482001094088164214236281311355
inhibition3184482001092170120140191212241262311361
of3569482001095076
platelet3668482001095273116214049600109307495139169
aggregation,2329496001094393143172216267310338358407457475
making28244960010975118160181231281
them3124496001093079124199
more33434960010975124153197
potent35604960010952101130174224252
antiplatelet2140510001094393121141192213256284328349394424
agents2585510001094393138187216252
than2858510001093079122171
P2Y123050510001094892138181220
inhibitors3291510001092170120140190211240288318353
(14).3666510001092567107130146
Despite21405240010961107142193215244289
the2453524001093080126
proven2603524001095281131173218268
efficacy2895524001094673102126166210251295
of3215524001095076
GPI33155240010959107127
in3467524001092171
primary35625240010952821031782222140538001093075
PCI22395380010948100120
settings,2383538001093681111142163212263298316
high2723538001095071121171
bleeding2918538001095172118163215235285335
rates3277538001093073102146182
remain3482538001093075150193213263
a37695380010943
concern.2140552001094088138178221250300319
In2479552001092271
a25715520010943
meta-analysis26355520010975120149193221264313356376418453473508
of3164552001094975
10,1233259552001094788106146185230
patients3510552001095195123143188238266302
undergoing2140566001095099149194223273322342391441
primary2597566001095281101176218247292
PCI,2905566001094899120138
Winchester3059566001097698147187236281316345389418
et3493566001094575
al.358456600109436482
(15)3682566001092667107130
reported2140580001092972121169197227270319
that2472580001092976118145
using2630580001094882101148197
GPI28395800010957103122
reduced2974580001092971121168207249298
non-fatal3285580001094996144171196238266308327
myocardial362558000109731131592140594001094083112162182224245
infarction239959400109217095139167206237257306356
(MI)2769594001092595116140
at2923594001094472
303009594001094691
days3115594001095093133168
(5.1%329759400109266986126191
vs.350259400109437897
8.3%;3613594001094665112181199
p21406080010950
<22046080010953
0.001)2270608001094662107153194212
with2495608001096686114162
a26716080010942
significant2727608001093554103151171196218257299347375
increase3115608001092169108136179221255299
in3427608001092169
cost3509608001094086120149
and3672608001094391140
risk214062200109295085126
of2283622001094975
minor2374622001097596145194223
bleeding2614622001095172117162213233283332
(3%2963622001092669139
vs.311862200109437897
1.7%;3232622001094660105175193
p34416220010951
<35096220010954
0.001).3579622001094664110157199217233
Based2140636001095095132178231
on23966360010951103
available2524636001094488132154175220272294341
data,2890636001095297127172191
current3107636001094192122152199250280
guidelines34126360010952103124176223245266317364401
state2140650001093666109138182
that2341650001093079122150
the2511650001093079124
routine2654650001093078127157177226271
use2944650001095085130
of3093650001095075
upstream31886500010949100135165194238281355
GPIs35626500010959106126161
in3742650001092171
STEMI2140664001094489134205227
cases2385664001094083118163198
is2601664001092156
not2675664001095099128
recommended,2822664001092973114162237311356405456501552570
but34106640010951101130
should3558664001093685134183204254
be2140678001095197
considered2259678001094189138173193243288317361412
for2694678001092775105
bailout2821678001095295115136185234263
if3107678001092147
there3177678001093079124153197
is3397678001092156
evidence3476678001094587108158203253293336
of2140692001094975
the2234692001093079124
no-reflow2377692001095099129159203229253302367
phenomenon27636920010951101146195244319364414463512
or3295692001094978
thrombotic3392692001093079108157231282331360381420
complications2140706001094088163213234255294338366387436485520
(Class267470600109267696138173208
IIa;289770600109214285102
LOE30147060010942102146
C)3175706001095278
(2).326870600109256992108
Our33917060010962112140
patient3546706001095195123144188238266
did2140720001095171121
not2282720001095099128
receive2430720001092974114158179222265
GPI27157200010959106126
therapy2861720001093079124153196247288
due31697200010951100144
to3334720001092978
its343272000109215086
unavailability35387200010950991421832262472140734001092266119141162184214260
at2426734001094474
the2526734001093081128
time2679734001093152129176
of2880734001095178
PCI.29837340010950103125145
Nevertheless,31537340010961108152197228261312359381428464501520
we36987340010969114
used2140748001095084129180
several2344748001093580122166195238259
strategies,262674800109366694138166210261281326361379
namely3028748001095093167212233276
MAT,33277480010972127166179
balloon3529748001095194115135184234284
angioplasty,2140762001094393143163212263285327362392437451
and2614762001094493144
intracoronary278176200109217199128172211259289337387430459504
thrombolysis,3308762001093079108157232282332353396431451486504
during2140776001095199128149198248
PCI24057760010948100120
to2542776001093078
obtain26377760010950101130173194243
good2897776001095099149200
results.3114776001093074109157178207243262
Anticoagulation3940590014370134170195248310365431494519573609634697762
Effective408076001094471101146188220241285329
anticoagulation443576001094393123144184233277328378399443472493543594
must5054760010975125160191
be527176001095197
maintained539376001097511914019039409000109307495145191243
during4204900010951100130151201252
primary447790001095181103178222251297
PCI4795900010948100121
to493790001093079
inhibit503790001092171121142194215246
the530390001093080126
coagulation54509000109408913339401040010951102124169199221272324
cascade4290104001094186123165210263309
and4626104001094495148
thrombus4800104001093081112162240292344380
formation.5207104001092677108186230261283334385405
Unfractionated39401180010960112140172219261295318370423469500547602
heparin45721180010952100154200232255307
(UFH)4910118001092687133193220
is5161118001092159
the5250118001093184132
most54121180010978130168200
widely3940132001096688140185207250
used4216132001095085131183
anticoagulant4425132001094393123144185234278329379400444494524
of4974132001094976
choice5076132001094090140162202247
for5348132001092777107
primary548013200109518210339401460010974117146191
PCI,4147146001094799120139
besides4301146001095196132152203248283
enoxaparin4600146001094494143184227277321350371420
and5036146001094392143
bivalirudin.5194146001095172116159180200229279330350400419
Heparin39401600010959105156201230252302
binds4258160001095173123174210
to4484160001093079
antithrombin,4579160001094494123144174224254303379430452502521
which51161600010967117138179229
causes5361160001094085134170216251
surface3940174001093686116146191233278
changes4244174001094192136187238285321
and4591174001094495147
deactivates4764174001095298142184217238283327358403440
thrombin.5230174001093080111161238290312363383
Antithrombin39401880010957110142165198251283336415470494547
binding4527188001095377130184208261315
blocks4882188001095377131175220261
two51841880010930103155
major53791880010978124148201234
factors3940202001092671111144193223259
of4216202001094976
the4309202001093079125
coagulation4451202001094089133184234255299328349399450
cascade:4918202001094084120161205256302320
thrombin5255202001093080109159234286307357
(Factor3940216001092567107146178226255
IIa)421021600109214285108
and4333216001094392142
Factor4490216001094382122153201230
Xa,4735216001095193112
blocking4862216001095072120161202224273322
the5200216001092978122
conversion53372160010940881371782222513940230001093657107157
of4122230001094976
fibrinogen4223230001092650101131153203253304350400
to4648230001093079
fibrin,4752230001092650101131153203222
thereby4999230001093080125155201252295
preventing53182300010952821271702152653940244001093052102154
clot4120244001094062113143
formation4289244001092777108184229259280331382
(15).4697244001092668110134152
Although4875244001095577108158209260311362
there5263244001093081127158204
are5492244001094474120
no39402580010950101
randomized,4067258001093074125177228304326365411464483
placebo-controlled4576258001095274118160205257308339383432483513544594616638684737
studies5338258001093668118170192238274
evaluating3940272001094588132154203247277298348399
UFH43562720010958103160
in4534272001092171
primary4622272001095181103178222251297
PCI,49372720010948100121141
there5095272001093080126156201
is5313272001092157
considerable53882720010940891391751963940286001095094123166216238282
experience4237286001094486137182211232276325365408
with4660286001096686116164
this483928600109307899133
agent.4987286001094392137186215233
Therefore,5235286001094494139168212238287316360377
the3940300001093079125
routine4080300001093079128158179229274
use4370300001094985130
of4516300001094975
UFH46073000010958102159
in4781300001092171
primary4868300001095180102176220249294
PCI51783000010947100120
remains5314300001092974149192213263298
a39403140010943
class4002314001094162106141177
I41983140010921
(LOE4238314001092668128173
A)4430314001095581
recommendation4530314001092974116165240315361412463507536557607658
(2).520731400109257094111
In4080328001092273
the4178328001093081127
ATOLL4331328001095696157201244
study4601328001093667117169213
involving4840328001092172115164186231253303355
9105221328001094690133
STEMI5380328001094491137210233
patients,3940342001095195124145190240269305324
enoxaparin4280342001094595144185228279323352373423
0.54718342001094664112
mg/kg48463420010975125157199249
IV5110342001092272
bolus51983420010951101122171207
compared54203420010940891633940356001095399130178232
to4201356001093182
UFH43123560010960106166
did4508356001095274128
not46653560010952104135
significantly4830356001093659112164186215240283329381412435480
reduce5339356001093178132184227273
the3940370001093081128
primary4094370001095283105182227257304
composite4424370001094191168220272309330361407
endpoint4857370001094697150202254276327358
of5241370001095077
30-day5345370001094794126180225267
death,3940384001095095138168217236
recurrent4191384001092974115164193223267317346
MI,4553384001097193112
procedural4681384001095180129170214265314343387408
failure,510438400109267091112161190234252
or5372384001094978
major546638400109741173940398001092272102
bleeding,4061398001095274119166217239289340359
but44393980010951102132
there4590398001093080126156201
was48113980010966110145
a49763980010943
decrease5039398001095196138167213256292338
in5396398001092171
the5487398001093080126
secondary3940412001093580121169219270313342387
endpoint4342412001094595145196246267317346
of4703412001094975
death,4794412001095095138167216235
recurrent5045412001092973114163192222267316345
MI,5406412001097193112
or5534412001094978
urgent3940426001094977126170219247
revascularization4202426001092972114156191230278299341369390427471499519568617
(16).4833426001092566107129145
In4993426001092170
contrast,5077426001094087136164192235269299317
a54094260010942
meta-analysis546642600109731183940440001093074103147197241262305341362398
of4356440001095076
234451440001094693
PCI45624400010948101122
studies4703440001093566116167189234270
(30,9664992440001092570116134179226274
patients,5285440001095195125146191242271308328
33%3940454001094690161
primary4121454001095181102178221251296
PCI)44374540010948101122147
reported4604454001092974126177207239284336
the4960454001093080125
superiority5105454001093685137183213235284314336366411
of5536454001095076
enoxaparin3940468001094697148190235287332362384435
over4401468001095094140170
UFH45974680010959104163
in4786468001092172
reducing4885468001092975128179221242293345
mortality52564680010976127158191236258280311357
and3940482001094394145
bleeding4102482001095173119165217238288339
outcomes44584820010949100130170218294340376
in4851482001092171
the4939482001093080125
context5081482001094189140169214257290
of5388482001094976
primary548148200109518110239404960010974117145190
PCI4145496001094798119
(17).4279496001092566105130146
Based4440496001094891126171221
on4676496001094998
these4789496001093079123158203
data,5007496001095093121164183
the5205496001092978123
routine5343496001092977126156176225269
use3940510001095087134
of4100510001095078
IV4204510001092274
enoxaparin4304510001094697148190235288333363386437
should4767510001093687138190212264
be50575100010952100
considered5183510001094191142179200253299330376429
during39405240010951100130152202252
primary4212524001095181102177221251296
PCI45275240010948101122
(Class466852400109267697141176212
IIa;489952400109214387105
LOE50245240010942102147
A)5190524001095681
(2).529052400109257094111
The4080538001094594138
use4237538001094983127
of4383538001094974
bivalirudin4476538001095171113155175194222270320339387
in4882538001092169
PCI4970538001094898118
has5106538001095092126
shown5250538001093684132197246
no5514538001095098
advantage3940552001094495138181231259303353398
over4361552001095092136165
UFH,45495520010959103160178
but47505520010952101131
data4903552001095295124167
have5093552001095194135179
shown5295552001093685135200251
a55685520010944
reduced3940566001092972121168207249298
risk425056600109294881121
of4383566001094973
major44685660010975116135183210
bleeding4690566001095171114158207226273322
in5023566001092169
a51045660010943
recent5159566001092971110152200228
meta­53985660010975118146188214
-analysis3940580001092869117159178219253272305
of4258580001094974
five434458000109264890132
trials448958000109295777118137171
(10,3504672580001092666106123169211255
patients),4939580001095193121140183232259294315330
although528158000109446391139187235284332
this394059400109297795128
was40805940010965107140
offset4231594001094973100135178206
by4449594001095090
an4550594001094391
increased4652594001092168107134176217250293342
risk500659400109294881121
of5139594001094873
acute5223594001094381128156198
stent5433594001093563105153180
thrombosis3940608001093078105153227276325358377411
(18).4364608001092565105128143
Based4519608001094991125169219
on4750608001095098
these4861608001092977121155199
data,5072608001095193120163180
the5265608001092977121
use5399608001094983127
of5538608001095074
bivalirudin3940622001095171113155175194222270320339388
as4345622001094377
an4439622001094392
anticoagulant4548622001094392119138177224267316363383425473501
during5066622001095199126146194243
primary532762200109517999172214242286
PCI39406360010949101122
procedures4085636001095282131172216268317346391427
is4535636001092156
recommended4614636001093175117165241317363413464509561
for5198636001092777106
class5327636001094262105140176
IIa552663600109224386
(LOE3940650001092666124167
A)4126650001095578
in4222650001092170
patients4310650001095194121141184233261296
with4624650001096686115163
a48056500010943
high4867650001095069118166
risk505265000109294982123
of5193650001095075
bleeding5286650001095171115160210229277326
or3940664001094978
class4031664001094060101135169
I42136640010922
recommendations4248664001092973113159233307351399449491519538586635668
(LOE4930664001092565124167
C)5110664001095378
for5201664001092674102
patients5317664001095193121140184233260296
with3940678001096686114163
heparin-induced4118678001095094144186214234282310330379428476515558608
thrombocytopenia4741678001093078106154228277326366409440487537582630650691
(2).544867800109256890106
PCI39407030014360129153
Strategy4122703001435690126181217273340394
ACS40807200010954104148
differs424472000109507097126170200235
from4495720001092656104178
stable4689720001093565109159181225
coronary4930720001093987117165215257286331
artery5276720001094372104148177222
disease55137200010950713940734001093580123157202
in4157734001092170
which42427340010965115135175224
the4481734001092978123
thrombus4619734001092978107155229280329364
burden4998734001095099128178223272
is5285734001092155
higher.5356734001094969119168213242256
Compression39407480010952101176228258303339375396445496
or4455748001094979
displacement4553748001095172108159181225265310386431482511
of5083748001095076
a51787480010944
thrombus5241748001092979109158234286336371
by3940762001095193
a40537620010944
balloon4116762001095296117138188239289
or4425762001095080
strut452476200109366797147177
stent4721762001093666111162191
can4932762001094084135
result5086762001093075111160182212
in5318762001092171
distal5408762001095172108139183205
embolization39407760010945120171221242263302346376396446496
and4452776001094392143
microvascular4611776001097596136165214256300335376425446489518
dysfunction.5145776001095193129156206256296328349398448467