Key result
Post-PCI parenteral anticoagulation shows no mortality benefit in high-thrombotic-risk STEMI.
Why the study?
The effectiveness of post procedural parenteral anticoagulation therapy in STEMI patients with high thrombotic risk remains uncertain despite guidelines advising against its routine use after PCI.
Does post-procedural parenteral anticoagulation therapy reduce in-hospital all-cause death or increase major bleeding in STEMI patients with high thrombotic risk following PCI?
Cohort (n=2,001)
Yes
Does post-procedural parenteral anticoagulation therapy reduce in-hospital all-cause death or increase major bleeding in STEMI patients with high thrombotic risk following PCI?
Odds Ratio: 0.7 (95% CI 0.33–1.48)
Absolute Event Rate: 2.1% vs 2.3%
p-value: p=0.349
No mortality benefit or excess bleeding with post-PCI parenteral anticoagulation in high-risk STEMI; supports guidelines but leaves open need for randomized confirmation.
Background: Current guidelines advise against routine use of parenteral anticoagulation therapy (PACT) for ST-segment elevated myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). However, the effectiveness of PACT in such patients with high thrombotic risk remains uncertain. To determine the impact of PACT on STEMI patients with high thrombotic risk. Methods: We enrolled STEMI patients with high thrombotic risk from four Chinese hospitals between 1 January 2010, and 31 December 2022. STEMI patients with high thrombotic risk were categorized them into PACT and non-PACT groups. We used multivariate, propensity score, and subgroup analyses to examine the relationship between PACT and clinical outcomes. The primary outcomes were in-hospital all-cause death and in-hospital major bleeding. Results: Out of 2,001 PCI patients, 473 received PACT. PACT was not associated with a lower all-cause death (adjusted OR, 0.70; 95% CI, 0.33-1.48; P = 0.349) and was not associated with an increased risk of major bleeding (adjusted OR, 0.84; 95% CI, 0.32-2.18; P = 0.720). After a median follow-up of 1.72 years, PACT did not significantly affect all-cause death and major adverse clinical events compared to non-PACT, as confirmed by propensity score and subgroup analyses. Conclusion: PACT was not statistically associated with a reduced risk of in-hospital all-cause death and an increased risk of major bleeding in STEMI patients with high thrombotic risk.
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Lai et al. (2026) conducted a cohort in ST-elevation myocardial infarction with high thrombotic risk (n=2,001). Parenteral anticoagulation therapy vs. No parenteral anticoagulation therapy was evaluated on In-hospital all-cause death (adjusted OR 0.70, 95% CI 0.33-1.48, p=0.349). Parenteral anticoagulation therapy after percutaneous coronary intervention was not associated with a reduced risk of in-hospital all-cause death (adjusted OR 0.70) or an increased risk of major bleeding in STEMI patients with high thrombotic risk.
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