PMID- 15701782
OWN - NLM
STAT- MEDLINE
DCOM- 20050506
LR  - 20071115
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 39
IP  - 3
DP  - 2005 Mar
TI  - Evolving role of low-molecular-weight heparins in ST-elevation myocardial 
      infarction.
PG  - 481-91
AB  - OBJECTIVE: To review the available literature on the efficacy and safety of 
      low-molecular-weight heparin (LMWH) in the treatment of ST-elevation myocardial 
      infarction (STEMI) in patients treated with fibrinolytic therapy or conservative 
      medical management. DATA SOURCES: A MEDLINE search (1966-March 2004) using the 
      key words myocardial infarction, STEMI, LMWH, enoxaparin, and dalteparin 
      identified pertinent articles. The references of these articles were reviewed for 
      additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: All human 
      trials of LMWH in STEMI were evaluated. All pertinent studies were included in 
      the review. DATA SYNTHESIS: LMWH did not show a benefit in STEMI without 
      fibrinolytic therapy. Enoxaparin is similar to intravenous unfractionated heparin 
      (UFH) in combination with nonspecific fibrinolytic therapy with regard to 
      invasive reperfusion markers and 30-day clinical outcomes. Enoxaparin decreases 
      composite endpoints in combination with fibrin-specific fibrinolytic therapy 
      compared with UFH, primarily through a reduction in the incidence of reinfarction 
      at 30 days. Bleeding rates with LMWH in combination with fibrinolytic agents are 
      not greater than those with UFH. CONCLUSIONS: Enoxaparin is a reasonable 
      alternative to UFH in patients with STEMI treated with fibrin-specific 
      fibrinolytic therapy. LMWH in patients managed with nonspecific fibrinolytic 
      therapy or conservative medical treatment does not provide an advantage over 
      standard management. Large clinical trials are ongoing which will provide more 
      definitive recommendations.
FAU - Kalus, James S
AU  - Kalus JS
AD  - Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health 
      Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 47201, USA.
FAU - Moser, Lynette R
AU  - Moser LR
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20050208
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Fibrinolytic Agents/administration & dosage/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/classification/*drug therapy/physiopathology
MH  - Randomized Controlled Trials as Topic
RF  - 49
EDAT- 2005/02/11 09:00
MHDA- 2005/05/07 09:00
CRDT- 2005/02/11 09:00
PHST- 2005/02/11 09:00 [pubmed]
PHST- 2005/05/07 09:00 [medline]
PHST- 2005/02/11 09:00 [entrez]
AID - aph.1E177 [pii]
AID - 10.1345/aph.1E177 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2005 Mar;39(3):481-91. doi: 10.1345/aph.1E177. Epub 2005 Feb 8.