PMID- 11489769
OWN - NLM
STAT- MEDLINE
DCOM- 20010913
LR  - 20190623
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 104
IP  - 6
DP  - 2001 Aug 7
TI  - Randomized comparison of enoxaparin, a low-molecular-weight heparin, with 
      unfractionated heparin adjunctive to recombinant tissue plasminogen activator 
      thrombolysis and aspirin: second trial of Heparin and Aspirin Reperfusion Therapy 
      (HART II).
PG  - 648-52
AB  - BACKGROUND: Adjunctive unfractionated heparin (UFH) during thrombolytic therapy 
      for acute myocardial infarction (AMI) promotes the speed and magnitude of 
      coronary artery recanalization and reduces reocclusion. Low-molecular-weight 
      heparins offer practical and potential pharmacological advantages over UFH in 
      multiple applications but have not been systematically studied as adjuncts to 
      fibrinolysis in AMI. METHODS AND RESULTS: Four hundred patients undergoing 
      reperfusion therapy with an accelerated recombinant tissue plasminogen activator 
      regimen and aspirin for AMI were randomly assigned to receive adjunctive therapy 
      for at least 3 days with either enoxaparin or UFH. The study was designed to show 
      noninferiority of enoxaparin versus UFH with regard to infarct-related artery 
      patency. Ninety minutes after starting therapy, patency rates (thrombolysis in 
      myocardial infarction [TIMI] flow grade 2 or 3) were 80.1% and 75.1% in the 
      enoxaparin and UFH groups, respectively. Reocclusion at 5 to 7 days from TIMI 
      grade 2 or 3 to TIMI 0 or 1 flow and TIMI grade 3 to TIMI 0 or 1 flow, 
      respectively, occurred in 5.9% and 3.1% of the enoxaparin group versus 9.8% and 
      9.1% in the UFH group. Adverse events occurred with similar frequency in both 
      treatment groups. CONCLUSIONS: Enoxaparin was at least as effective as UFH as an 
      adjunct to thrombolysis, with a trend toward higher recanalization rates and less 
      reocclusion at 5 to 7 days.
FAU - Ross, A M
AU  - Ross AM
AD  - Cardiovascular Research Institute, Institute of Medicine, George Washington 
      University, Washington, DC, USA. allanmross@aol.com
FAU - Molhoek, P
AU  - Molhoek P
FAU - Lundergan, C
AU  - Lundergan C
FAU - Knudtson, M
AU  - Knudtson M
FAU - Draoui, Y
AU  - Draoui Y
FAU - Regalado, L
AU  - Regalado L
FAU - Le Louer, V
AU  - Le Louer V
FAU - Bigonzi, F
AU  - Bigonzi F
FAU - Schwartz, W
AU  - Schwartz W
FAU - de Jong, E
AU  - de Jong E
FAU - Coyne, K
AU  - Coyne K
CN  - HART II Investigators
LA  - eng
PT  - Clinical Trial
PT  - Clinical Trial, Phase II
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Aspirin/*therapeutic use
MH  - Coronary Angiography
MH  - Coronary Circulation/drug effects
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Female
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/therapeutic use
MH  - Humans
MH  - Intracranial Hemorrhages/chemically induced
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/mortality/physiopathology
MH  - Myocardial Reperfusion
MH  - Recombinant Proteins/therapeutic use
MH  - Survival Rate
MH  - Thrombolytic Therapy
MH  - Tissue Plasminogen Activator/*therapeutic use
MH  - Treatment Outcome
EDAT- 2001/08/08 10:00
MHDA- 2001/09/14 10:01
CRDT- 2001/08/08 10:00
PHST- 2001/08/08 10:00 [pubmed]
PHST- 2001/09/14 10:01 [medline]
PHST- 2001/08/08 10:00 [entrez]
AID - 10.1161/hc3101.093866 [doi]
PST - ppublish
SO  - Circulation. 2001 Aug 7;104(6):648-52. doi: 10.1161/hc3101.093866.