Nitroglycerin and Heparin Coadministration

Primary Considerations

• The American Heart Association and American College of Cardiology recommend the use of intravenous nitroglycerin in patients with acute coronary syndromes, who are typically already receiving anticoagulation including heparin 1, 2, 3

Absolute Contraindications to Nitroglycerin

• The American Heart Association recommends against administering nitroglycerin to patients with hypotension (SBP <90 mm Hg or ≥30 mm Hg below baseline) 4, 5, 3
• The American Heart Association recommends against administering nitroglycerin to patients with recent phosphodiesterase inhibitor use (within 24 hours of sildenafil/vardenafil or 48 hours of tadalafil) 3
• The American Heart Association recommends against administering nitroglycerin to patients with right ventricular infarction, where preload reduction can cause hemodynamic collapse 1, 5, 3
• The American Heart Association recommends against administering nitroglycerin to patients with severe bradycardia (<50 bpm) or tachycardia (>100 bpm in absence of heart failure) 4