PMID- 14743848
OWN - NLM
STAT- MEDLINE
DCOM- 20040603
LR  - 20200225
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 27
IP  - 1
DP  - 2004 Jan
TI  - Optimizing adjunctive antithrombotic therapy in the treatment of acute myocardial 
      infarction: a role for low-molecular-weight heparin.
PG  - 3-8
AB  - Thrombotic complications account for a large proportion of in-hospital deaths 
      from acute myocardial infarction (MI). Although thrombolytic therapy has greatly 
      improved clinical outcomes following MI, thrombin released during clot lysis has 
      a prothrombotic effect, and the thrombolytic agents themselves may directly 
      activate platelets. Antithrombotic therapy as an adjunct to thrombolysis improves 
      the speed and extent of artery recanalization and reduces the incidence of 
      secondary ischemic complications. The current treatment standard is 
      unfractionated heparin (UFH) administered intravenously for 24-48 h. However, UFH 
      has not been unequivocally shown to improve outcomes in large-scale, randomized 
      clinical trials, and shows no evidence of benefit when used as an adjunct to 
      streptokinase-based thrombolysis. Unfractionated heparin also has several 
      clinical and practical disadvantages, such as the need for coagulation 
      monitoring, difficulties attaining a stable and reliable anticoagulant effect, 
      and the risk of hemorrhagic side effects. Low-molecular-weight heparin (LMWH) 
      represents a safe and effective alternative antithrombotic therapy, with a stable 
      and predictable anticoagulant effect, potential for use in combination with 
      either fibrin-specific or streptokinase-based thrombolysis, no need for 
      anticoagulation monitoring, and a low risk of hemorrhagic and other 
      heparin-related complications. Several randomized clinical trials have shown that 
      adjunctive LMWH is at least as effective as UFH in the acute phase of MI, is 
      associated with fewer in-hospital recurrent ischemic events, and has an 
      acceptable safety profile.
FAU - Brieger, David
AU  - Brieger D
AD  - Department of Cardiology, University of Sydney, Sydney, New South Wales, 
      Australia. davidb@email.cs.nsw.gov.au
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.- (Streptokinase)
SB  - IM
MH  - Drug Therapy, Combination
MH  - Emergency Medical Services
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - Secondary Prevention
MH  - Streptokinase/therapeutic use
MH  - Thrombolytic Therapy/*methods
PMC - PMC6654070
EDAT- 2004/01/28 05:00
MHDA- 2004/06/04 05:00
PMCR- 2006/12/05
CRDT- 2004/01/28 05:00
PHST- 2004/01/28 05:00 [pubmed]
PHST- 2004/06/04 05:00 [medline]
PHST- 2004/01/28 05:00 [entrez]
PHST- 2006/12/05 00:00 [pmc-release]
AID - CLC4960270103 [pii]
AID - 10.1002/clc.4960270103 [doi]
PST - ppublish
SO  - Clin Cardiol. 2004 Jan;27(1):3-8. doi: 10.1002/clc.4960270103.