How soon can anticoagulation with unfractionated heparin per acute coronary syndromes protocol be safely started

Starting heparin post successful primary percutaneous coronary intervention is not common practice unless the patient has an Impella or intra-aortic balloon pump, or you have other reasons to start anticoagulation. Heparin can start 1 hour post removal of the TR Band; however, anticoagulation does not need to be interrupted to remove the TR Band. If the patient is on active anticoagulation, I will leave the TR Band inflated with patent hemostasis for 2 hours, then I start removing the TR Band by deflating 2 mL every 15 minutes.

Author: 

Khaldoon Alaswad, MD, RVT, FACC, FSCAI
Director, Cardiac Catheterization Laboratory
Edith and Benson Ford Heart and Vascular Institute
Henry Ford Hospital
Henry Ford Health System
Detroit, MI

Question: 

How soon can anticoagulation with unfractionated heparin per acute coronary syndromes protocol be safely started for an ST-elevation myocardial infarction (STEMI) patient with respect to TR Band removal? Usually we wait 2-4 hours post transradial cath to relieve the TR Band, but in a STEMI situation, it seems like a long time without anticoagulation.