[Soul]

Thanx rajupangeni for this superb info....

Ya its true that heparin is not given when streptokinase is used as a fibrinolytic, but it is reasonable to give concomitant heparin if risk of DVT, PE is high, if the pt had prevly developed such conditions. however it increases the risk of major bleeding, so guideline also doesn't support routine use of heparin with streptokinase.

LMWH (enoxaparin) has been recently approved by FDA for use in STEMI. Might be due to the results of exTRACT-TIMI 25. Though LMWH increases the risk of major bleeding, the net clinical benefit (death, non fatal MI) is superior to UFH.

PCI has become the 'therapy of choice' in STEMI, and I also believe that PCI is more cost-effective than fibrinolytics in STEMI. Fibrinolytics are RARELY used in our hosp, so I was curious to know the protocol at other hosp. Thanx again for such a valuable info.