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Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: an ExTRACT-TIMI 25 analysis.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Giraldez, Roberto Rocha Nicolau, José Carlos Corbalán, Ramón Gurfinkel, Enrique P. Juárez, Ursulo López-Sendón, José Luís Parkhomenko, Alexander Ya. Molhoek, Peter Mohanavelu, Satishkumar Morrow, David A. Antman, Elliott M. |
| Copyright Year | 2007 |
| Abstract | AIMS We compared outcomes of ST-elevation myocardial infarction (STEMI) patients randomized to a strategy of either enoxaparin or unfractionated heparin (UFH) to support fibrinolysis. METHODS AND RESULTS In the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis in Myocardial Infarction Study 25 (ExTRACT-TIMI 25) trial, 20,479 patients undergoing fibrinolysis for STEMI with a fibrin-specific agent (N = 16,283) or streptokinase (SK) (N = 4139) were randomized to enoxaparin throughout their hospitalization or UFH for at least 48 h. The primary end point of death or nonfatal recurrent MI through 30 days occurred in 12.0% of patients in the UFH and 9.8% in the enoxaparin groups when treated with fibrin-specific lytics [odds ratio(adjusted) (OR(adj)) 0.78; 95% CI 0.70-0.87; P < 0.001] and 11.8 vs. 10.2%, respectively, when treated with SK (OR(adj) 0.83; 95% CI 0.66-1.04; P = 0.10; P(interaction) = 0.58). Major bleeding rates including intracranial hemorrhage within the fibrin-specific cohort were 1.2 and 2.0% in the UFH and enoxaparin groups, respectively (P < 0.001) and 2.0% in UFH and 2.4% in enoxaparin patients in the SK cohort (P = 0.16). Interaction tests between antithrombin- and lytic-type were non-significant (P = 0.20). Death, nonfatal MI, or major bleeding was significantly reduced with enoxaparin in the fibrin-specific cohort (OR(adj) 0.82; 95% CI 0.74-0.91; P < 0.001) and favoured enoxaparin in the SK cohort (OR(adj) 0.89; 95% CI 0.72-1.10; P = 0.29; P(interaction) = 0.53). CONCLUSION The benefits of an enoxaparin strategy over UFH were observed in both SK and fibrin-specific-treated STEMI patients. Therefore, an enoxaparin strategy is preferred over UFH to support fibrinolysis for STEMI regardless of lytic agent. |
| File Format | PDF HTM / HTML |
| DOI | 10.1093/eurheartj/ehm179 |
| PubMed reference number | 17562672 |
| Journal | Medline |
| Volume Number | 28 |
| Issue Number | 13 |
| Alternate Webpage(s) | https://watermark.silverchair.com/ehm179.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAlAwggJMBgkqhkiG9w0BBwagggI9MIICOQIBADCCAjIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMwOWqobZPrUZZW4SkAgEQgIICA1IjcZ6CfMm87jHxXKDkg2pkNMOMN73Fy2SxrtaFT9KFd31Wn7jY6wBFOYFmejs1soP0sDA7RBNx5NZzQWmgEz52YjQHaoT-hrz3yKV4kwpFNgIQGvbCqG4NI7_kNFO3I09xrHQUvy0SKwlu63VougNQefaC4T9aOXsZ8dNwSlm8CUnaotwQ-r9-R8Zl6l-7MTKbngI0aS34WbrYjjR3JCunWpVr0x7B5XZeJTi4D_9tsUfZE6dIvav2dPG2WMX9UM0pSO2da2ShekRmHA4VLvdw1keZOX7H7g43R_JEycoIBQan_voSNif7C6KIyErbocYWvNt95ZZqlWAGDe-s_Mz1J_W5koYzb9xsmcqVydPd-Xw6BSecF23itsJzoYnyO_ql2-E9xKyCN0SDCh5KVMy70kBC2-GkZ2mrsVwQi3boDGbzfNu8RNHz9oMT9_Q7Hlgtav4bk10rQpKfv1wtGdnLHMyL0adFlVDqAGUVAETOPwKeTFS-OVv-U54DXxhTh4K2_hy6wQcxGLevEGxxqLBEmmdxKsiLDT1GkMwfqRt4-TKq7B20r51LFZThEe__Ppw0jCvzKqzoyDTHM-9PyKAKn41xE9iLKwD3123_f1Y0aK4O0NQ1yN165KE8SamJ3eOCFfVW7tMER8WYcjKRDVR__GKs9Pshy9oxW923XewSur9V |
| Alternate Webpage(s) | http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.534.6513&rep=rep1&type=pdf |
| Alternate Webpage(s) | https://doi.org/10.1093/eurheartj%2Fehm179 |
| Journal | European heart journal |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
