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
In: European heart journal, Jg. 28 (2007), Heft 13, S. 1566-1573
Online
academicJournal
- print, 16 ref
Zugriff:
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 ratioadjusted (ORadj) 0.78; 95% Cl 0.70-0.87; P < 0.001] and 11.8 vs. 10.2%, respectively, when treated with SK (ORadj 0.83; 95% Cl 0.66-1.04; P = 0.10; Pinteraction = 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 (ORadj 0.82; 95% Cl 0.74-0.91; P < 0.001) and favoured enoxaparin in the SK cohort (ORadj 0.89; 95% Cl 0.72-1.10; P = 0.29; Pinteraction = 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.
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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
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Autor/in / Beteiligte Person: | GIRALDEZ, Roberto R ; NICOLAU, José Carlos ; ANTMAN, Elliott M ; CORBALAN, Ramon ; GURFINKEL, Enrique P ; JUAREZ, Ursulo ; LOPEZ-SENDON, Jose ; PARKHOMENKO, Alexander ; MOLHOEK, Peter ; MOHANAVELU, Satishkumar ; MORROW, David A |
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Zeitschrift: | European heart journal, Jg. 28 (2007), Heft 13, S. 1566-1573 |
Veröffentlichung: | Oxford: Oxford University Press, 2007 |
Medientyp: | academicJournal |
Umfang: | print, 16 ref |
ISSN: | 0195-668X (print) |
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