PMID- 12714021
OWN - NLM
STAT- MEDLINE
DCOM- 20030626
LR  - 20190513
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 24
IP  - 10
DP  - 2003 May
TI  - Low molecular weight heparin (dalteparin) compared to unfractionated heparin as 
      an adjunct to rt-PA (alteplase) for improvement of coronary artery patency in 
      acute myocardial infarction-the ASSENT Plus study.
PG  - 897-908
AB  - BACKGROUND: Current thrombolytic-antithrombotic regimens in acute 
      myocardialinfarction (AMI) are limited by incomplete early coronary reperfusion 
      and by reocclusion and reinfarction. We compared the effects of low molecular 
      weight heparin (LMWH) versus unfractionated heparin (UFH) as an adjunct to 
      recombinant tissue-plasminogen activator (alteplase) on coronary artery patency 
      and clinical outcomes in AMI. METHODS: Patients with AMI treated with alteplase 
      (n=439) were randomised to either subcutaneous dalteparin (120 IU/kg every 12h) 
      for 4-7 days or intravenous infusion of UFH for 48 h. Coronary angiography was 
      performed between day 4 and hospital discharge. Clinical events and safety were 
      evaluated until day 30. RESULTS: Overall there were higher thrombolysis in 
      myocardial infarction (TIMI) flows in the infarct related coronary artery in the 
      dalteparin group (p=0.016). The predefined primary end-point, TIMI grade 3 flow, 
      did not reach statistical significance (dalteparin 69.3% versus heparin 62.5%; 
      p=0.163). However, TIMI 0-1 flow (13.4 versus 24.4%; p=0.006) and its combination 
      with intraluminal thrombus (27.9 versus 42.0%; p=0.003) were less common in the 
      dalteparin group. During the period of randomised treatment there were less 
      myocardial reinfarctions in the dalteparin group(p=0.010) but after cessation of 
      dalteparin there were more reinfarctions resulting in no difference in death or 
      MI at 30 days. There were no significant differences in major bleeding or stroke 
      after 30 days. CONCLUSIONS: In alteplase treated AMI adjunctive dalteparin for 
      4-7 days seems to reduce the risk of early coronary artery occlusion and 
      reinfarction. However, early after cessation of treatment there is a raised risk 
      of events, which might eliminate any long-term gains.
FAU - Wallentin, Lars
AU  - Wallentin L
AD  - Department of Medical Sciences, Cardiology, University Hospital, S-751 85, 
      Uppsala, Sweden. lars.wallentin@thorax.uas.lul.se
FAU - Bergstrand, Lott
AU  - Bergstrand L
FAU - Dellborg, Mikael
AU  - Dellborg M
FAU - Fellenius, Carin
AU  - Fellenius C
FAU - Granger, Christopher B
AU  - Granger CB
FAU - Lindahl, Bertil
AU  - Lindahl B
FAU - Lins, Lars Eric
AU  - Lins LE
FAU - Nilsson, Tage
AU  - Nilsson T
FAU - Pehrsson, Kenneth
AU  - Pehrsson K
FAU - Siegbahn, Agneta
AU  - Siegbahn A
FAU - Swahn, Eva
AU  - Swahn E
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - R16CO5Y76E (Aspirin)
RN  - S79O08V79F (Dalteparin)
RN  - X85G7936GV (Abciximab)
SB  - IM
MH  - Abciximab
MH  - Administration, Cutaneous
MH  - Aged
MH  - Antibodies, Monoclonal/administration & dosage
MH  - Anticoagulants/*administration & dosage
MH  - Aspirin/administration & dosage
MH  - Blood Flow Velocity
MH  - Chemotherapy, Adjuvant
MH  - Coronary Angiography
MH  - Dalteparin/administration & dosage
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Immunoglobulin Fab Fragments/administration & dosage
MH  - Infusions, Intravenous
MH  - Male
MH  - Myocardial Infarction/*drug therapy
MH  - Myocardial Revascularization
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Recurrence
MH  - Tissue Plasminogen Activator/*administration & dosage
MH  - Treatment Outcome
MH  - Vascular Patency
EDAT- 2003/04/26 05:00
MHDA- 2003/06/27 05:00
CRDT- 2003/04/26 05:00
PHST- 2003/04/26 05:00 [pubmed]
PHST- 2003/06/27 05:00 [medline]
PHST- 2003/04/26 05:00 [entrez]
AID - S0195668X0300006X [pii]
AID - 10.1016/s0195-668x(03)00006-x [doi]
PST - ppublish
SO  - Eur Heart J. 2003 May;24(10):897-908. doi: 10.1016/s0195-668x(03)00006-x.