TITLE

Efficacy and safety of unfractionated heparin versus enoxaparin: a pooled analysis of ASSENT-3 and -3 PLUS data

AUTHOR(S)
Armstrong, Paul W.; Wei-Ching Chang; Wallentin, Lars; Goldstein, Patrick; Granger, Christopher B.; Bogaerts, Kris; Danays, Thierry; Van de Werf, Frans
PUB. DATE
May 2006
SOURCE
CMAJ: Canadian Medical Association Journal;5/9/2006, Vol. 174 Issue 10, p1421
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The optimal antithrombotic therapy to accompany tenecteplase in cases of acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We undertook a prespecified pooled analysis of data from the ASSENT- 3 and ASSENT-3 PLUS trials. Methods: We created a combined database of the 2040 and 818 patients who received enoxaparin in ASSENT-3 and ASSENT- 3 PLUS, respectively, and compared them with the 2038 and 821 patients who received unfractionated heparin. Results: The primary efficacy end point, a composite of 30- day mortality, reinfarction or refractory ischemia, was 16.0% with enoxaparin versus 12.2% with unfractionated heparin ( p < 0.001); the efficacy plus safety (intracranial hemorrhage [ICH] or major systemic bleeding) end point, 18.0% versus 15.0% ( p= 0.003). The 1049 patients urgently revascularized had greater benefit from enoxaparin (15.4% v. 10.1%, p= 0.013), yet the excess in major systemic bleeding evident with enoxaparin (3.3% v. 2.4%, p= 0.01) was largely confined to the 3492 patients without or before revascularization. Although ICH rates in the groups were similar (1.3% v. 0.9%, p= 0.26), an excess of ICH occurred among those administered enoxaparin during the ASSENT-3 PLUS trial (6.7% v. 0.8%, p= 0.013), especially among women over 75 years of age. Interpretation: These data demonstrated the benefit of enoxaparin used in conjunction with tenecteplase, but raised caution about its prehospital use to treat STEMI in elderly women.
ACCESSION #
21062637

 

Related Articles

  • Efficacy and Safety of Bivalirudin Versus Heparins in Reduction of Cardiac Outcomes in Acute Coronary Syndrome and Percutaneous Coronary Interventions. Singh, Sarabjeet; Molnar, Janos; Arora, Rohit // Journal of Cardiovascular Pharmacology & Therapeutics;Dec2007, Vol. 12 Issue 4, p283 

    The article examines the efficacy and safety of bivalirudin versus heparins in reducing cardiac outcomes in acute coronary syndrome and percutaneous interventions. The confidence intervals of death, myocardial infarction and revascularization were computed. Bivalirudin monotherapy was found to...

  • PRIMENA NISKOMOLEKULARNIH HEPARINA U AKUTNOM ST ELEVIRANOM INFARKTU MIOKARDA. Petrović, Milovan; Panić, Gordana; Čanji, Tibor; Srdanović, Ilija; Ivanović, Vladimir; Benc, Dragan // Medicinski Pregled / Medical Review;2006, Vol. 59 Issue 9/10, p476 

    Introduction. According to the published guidelines for the management of acute coronary syndromes (ACS), treatment of acute ST-elevated myocardial infarction is based on rapid revascularization, either mechanical or pharmacological. Pharmacological revascularization consists of fibrinolytic...

  • Antithrombotic Agents for Acute Coronary Syndromes. Mukherjee, Debabrata // Cardiovascular & Hematological Agents in Medicinal Chemistry;2008, Vol. 6 Issue 2, p130 

    Current evidence suggests a central role for antithrombotic agents such as unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in the management of acute coronary syndromes (ACS). In patients with acute myocardial infarction, several studies have shown that LMWHs may represent an...

  • Bivalirudin superior to heparin in pre-hospital setting for patients with STEMI.  // Cardiology Today;Dec2013, Vol. 16 Issue 12, p16 

    The article discusses findings of a EUROMAX trial indicating better outcomes with ST segment evaluation myocardial infarction (STEMI) anticoagulant bivalirudin in patients who need percutaneous coronary intervention (PCI) as compared to using heparin with or without glycoprotein IIb/IIa inhibitors.

  • Treatment with Bivalirudin (Hirulog) as Compared with Heparin during Coronary Angioplasty for Unstable or Postinfarction Angina. Bittl, John A.; Strony, John; Brinker, Jeffrey A.; Ahmed, Waqar H.; Meckel, Clyde R.; Chaitman, Bernard R.; Deutsch, Ezra; Adelman, Burt // New England Journal of Medicine;9/21/95, Vol. 333 Issue 12, p764 

    Background: Heparin is often administered during and after coronary angioplasty to prevent closure of the dilated vessel. However, ischemic or hemorrhagic complications occur in 5 to 10 percent of treated patients. We studied whether these complications could be prevented when the direct...

  • Percutaneous coronary intervention in patients with active bleeding or high bleeding risk. Nguyen, James; Nguyen, Thach // Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi;Mar2013, Vol. 13 Issue 2, p165 

    There isa lack of evidence from randomized clinical trials (RCT) supporting percutaneous coronary intervention (PCI) in patients with high bleeding risk or active bleeding. The management decisions are based on extrapolation of subgroups data in RCTs or experts' opinions. Bleeding in the...

  • Association Between the Use of Fondaparinux vs Low-Molecular-Weight Heparin and Clinical Outcomes in Patients With Non-ST-Segment Elevation Myocardial Infarction. Szummer, Karolina; Oldgren, Jonas; Lindhagen, Lars; Carrero, Juan Jesus; Evans, Marie; Spaak, Jonas; Edfors, Robert; Jacobson, Stefan H.; Andell, Pontus; Wallentin, Lars; Jernberg, Tomas // JAMA: Journal of the American Medical Association;2/17/2015, Vol. 313 Issue 7, p707 

    IMPORTANCE: Fondaparinux was associated with reduced major bleeding events and improved survival compared with low-molecular-weight heparin (LMWH) in a large randomized clinical trial involving patients with non-ST-segment elevation myocardial infarction (NSTEMI). Large-scale experience of the...

  • MEDICINE IN THE NEWS. Kaplan, Deborah // Patient Care for the Nurse Practitioner;Nov2005, Vol. 8 Issue 11, p10 

    The article provides information from studies on warfarin use. Warfarin plus aspirin was associated with lower annual recurrence rate of myocardial infarction, annual incidence rate of ischemic stroke, and need for revascularization, compared with aspirin alone. Investigators of a study of...

  • LONG-TERM USE OF ANTICOAGULANTS FOLLOWING ACUTE MYOCARDIAL INFARCTION. Cosby, Richard S.; Herman, Lawrence M.; Talbot, John C.; Mayo, Mary // Angiology;Jan1964, Vol. 15 Issue 1, p57 

    Focuses on the beneficial effect of long-term anticoagulant therapy on patients suffering from myocardial infarction. Improvement on the quality of life; Reduction on the risks of bleeding episodes; Description on the physical condition of the patients.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics