Table of Contents
ISRN Cardiology
Volume 2014, Article ID 416253, 11 pages
http://dx.doi.org/10.1155/2014/416253
Review Article

Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

1Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil
2Serviço de Hemodinâmca do Hospital Universitário São José (INCOR Minas), Rua Aimorés 2896, Barro Preto, 30140-073 Belo Horizonte, MG, Brazil
3Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil
4Departamento de Estatística, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6.627, Campus Pampulha, 31270-901 Belo Horizonte, MG, Brazil

Received 14 October 2013; Accepted 26 November 2013; Published 6 February 2014

Academic Editors: P. Marino and M. Takahashi

Copyright © 2014 Bruno Ramos Nascimento et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death ( , ) and MB ( , ), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death ( , ), MB ( , ), and AMI ( , ). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.