Low molecular weight heparin is not a safe alternative in this patient group. However, agents such as bivalrudin and fondaparanux are safe and effective. The use of these agents remains pivotal in treatment of both STEMI patients receiving thrombolytic therapy and in patients with NONSTEMI or unstable angina
Medication noncompliance, poor understanding of discharge instruction, congestive heart failure and chest pain remain the most common reasons. It is imperative that patients with AMI have early follow-up after discharge, best within 3-5 days, for medication reconciliation and review of activity instructions. Be aware of patients at highest risk for heart failure (older patients, anterior infarctions, patients with bypass at the time of infarction, and those with mechanical complications of infarction such as ischemic mitral regurgitation).