PMID- 14551516
OWN - NLM
STAT- MEDLINE
DCOM- 20040621
LR  - 20071115
IS  - 0026-4725 (Print)
IS  - 0026-4725 (Linking)
VI  - 51
IP  - 5
DP  - 2003 Oct
TI  - Enoxaparin for the treatment of acute myocardial infarction with persistent 
      ST-segment elevation.
PG  - 463-70, 470-4
AB  - Enoxaparin (E) is a low-molecular-weight heparin which has been proven more 
      effective than unfractionated heparin (UFH) for the treatment of non-ST-segment 
      elevation acute coronary syndromes. Limited and inconclusive on the other hand, 
      are the data on the use of E in acute myocardial infarction with persistent 
      ST-segment elevation (STEAMI). Therefore, we performed a review of the literature 
      in order to evaluate the level of evidence relative to the efficacy and safety of 
      E in such a clinical setting. The effect of E in STEAMI has been evaluated in 7 
      clinical studies, including a total of about 9500 patients. Compared to placebo, 
      E resulted more effective on the incidence of the combined end-point of death, 
      re-infarction and recurrent angina in the study by Glick et al. and on the 
      patency of the infarct-related artery in the AMI-SK study. Compared to UFH, E 
      resulted more effective on the incidence of the combined end-point of death, 
      reinfarction and unstable angina in the study by Baird et al. and of in-hospital 
      re-infarction and refractory ischemia rates in both ASSENT-3 and ASSENT-3 PLUS, 
      while the effect on the patency of the infarct-related artery, which was 
      evaluated in HART-II and ENTIRE-TIMI 23, resulted non univocal. Overall, bleeding 
      complications were more frequent than with placebo and comparable to UFH, with 
      the exception of ASSENT-3 PLUS where pre-hospital administration of E was 
      associated with a doubled incidence of intracranial bleeding (although only in 
      patients older than 75 years). In conclusion, the administration of E, in 
      association with aspirin and thrombolytics, already appears a possible 
      therapeutic option for the treatment of STEAMI, due to its good efficacy and 
      safety profile, along with its easiness of use. However, prior to have its use 
      recommended, the current B level of evidence of a superior efficacy and safety 
      compared to UFH needs to be reinforced. Further-more, some open issues relative 
      to the use of E in particular settings (aged patients, in association with 
      glycoprotein IIb/IIIa inhibitors and during percutaneous coronary 
      revascularization) need to be clarified.
FAU - Rubboli, A
AU  - Rubboli A
AD  - Catheterization Laboratory, Cardiology Unit, S. Maria delle Croci Hospital, 
      Ravenna, Italy. andrearubboli@libero.it
FAU - Herzfeld, I
AU  - Herzfeld I
FAU - Maresta, A
AU  - Maresta A
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - Minerva Cardioangiol
JT  - Minerva cardioangiologica
JID - 0400725
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Electrocardiography
MH  - Enoxaparin/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/physiopathology
RF  - 20
EDAT- 2003/10/11 05:00
MHDA- 2004/06/24 05:00
CRDT- 2003/10/11 05:00
PHST- 2003/10/11 05:00 [pubmed]
PHST- 2004/06/24 05:00 [medline]
PHST- 2003/10/11 05:00 [entrez]
PST - ppublish
SO  - Minerva Cardioangiol. 2003 Oct;51(5):463-70, 470-4.