What should be considered in patients with large anterior infarctions who do not receive fibrinolysis or PCI?

In the case of patients with large anterior infarctions who do not receive fibrinolysis or percutaneous coronary intervention (PCI), the use of heparin is a critical consideration. Heparin acts as an anticoagulant, which can help prevent further thrombus formation and facilitate blood flow in the coronary arteries. In the setting of an acute myocardial infarction, particularly with large anterior wall involvement, the risk of further ischemia and complications increases. Therefore, administering heparin can provide a therapeutic benefit by improving outcomes and reducing the risk of adverse events associated with coronary occlusion.

Other options, such as immediate surgery or transferring for surgery, may not be appropriate in the acute management of these patients unless there are specific complications or other clinical indications that warrant such interventions. Increased bed rest, while it may be necessary for stabilization, does not address the underlying problem of the coronary artery occlusion and does not provide therapeutic benefits that anticoagulation with heparin would. This makes the use of heparin the most pertinent choice for patients in this situation.