PMID- 16269997
OWN - NLM
STAT- MEDLINE
DCOM- 20051130
LR  - 20191026
IS  - 0755-4982 (Print)
IS  - 0755-4982 (Linking)
VI  - 34
IP  - 18
DP  - 2005 Oct 22
TI  - New anticoagulants in ischemic heart disease.
PG  - 1325-9
AB  - Fibrinolysis is the reference treatment for most myocardial infarctions with 
      ST-segment elevation; alternatives are angioplasty, with or without stent. The 
      earlier fibrinolysis is performed (preferably before hospitalization), the more 
      effective it is. It can be optimized by adjuvant antiplatelet therapy, such as 
      aspirin, and probably by anticoagulant treatment as well. Because fibrinolytic 
      therapy is accompanied by intensive thrombin generation and activation, immediate 
      and continuous adjunctive simultaneous heparin therapy is recommended. The 
      efficacy of subcutaneous low-molecular-weight heparin (LMWH) HBPM) is at least 
      equivalent to that of intravenous unfractionated heparin (UFH), but its risk of 
      severe (but not cerebral) hemorrhage is greater. Bolus LMWH on the other hand is 
      associated with an increased risk of cerebral hemorrhage. Antithrombotic 
      treatment thus appears optimal with bolus UFH at fibrinolysis and for at least 48 
      hours afterwards. An alternative after this bolus might be subcutaneous 
      enoxaparin until discharge. Because the major drawback of both types of heparin 
      is their rebound activation of thrombosis, oral anticoagulants are recommended 
      thereafter. The combination of anticoagulant treatment + (low-dose) aspirin is 
      not superior to aspirin alone when the target INR is below 2. Adequate 
      anticoagulation with INRs greater than 2.0 consistently improves angiographic and 
      clinical outcome. Bleeding (except intracerebral) is significantly increased 
      whether the INR is greater than or less than 2.0. Other treatments are being 
      investigated. Pentasaccharide (anti-Xa) combined with fibrinolysis seems to 
      reduce reocclusion more effectively than UFH. Oral postinfarction treatment with 
      ximelagatran (a thrombin inhibitor), combined with aspirin, is associated with 
      fewer cardiovascular events than aspirin alone. More studies are needed.
FAU - Verheugt, F W A
AU  - Verheugt FW
AD  - Department of Cardiology, University Medical Center St Radboud, Nijmegen, The 
      Netherlands. f.verheugt@cardio.umcn.nl
LA  - eng
PT  - Journal Article
PT  - Review
PL  - France
TA  - Presse Med
JT  - Presse medicale (Paris, France : 1983)
JID - 8302490
RN  - 0 (Anticoagulants)
RN  - 0 (Azetidines)
RN  - 0 (Benzylamines)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 49HFB70472 (ximelagatran)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Aspirin/administration & dosage/therapeutic use
MH  - Azetidines/administration & dosage/therapeutic use
MH  - Benzylamines
MH  - Cerebral Hemorrhage/chemically induced
MH  - Coronary Thrombosis/drug therapy
MH  - Drug Therapy, Combination
MH  - Factor Xa/drug effects
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Follow-Up Studies
MH  - Forecasting
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse effects/therapeutic 
      use
MH  - Humans
MH  - Injections, Intravenous
MH  - Injections, Subcutaneous
MH  - Myocardial Infarction/drug therapy
MH  - Myocardial Ischemia/*drug therapy
MH  - Platelet Aggregation Inhibitors/administration & dosage/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
RF  - 34
EDAT- 2005/11/05 09:00
MHDA- 2005/12/13 09:00
CRDT- 2005/11/05 09:00
PHST- 2005/11/05 09:00 [pubmed]
PHST- 2005/12/13 09:00 [medline]
PHST- 2005/11/05 09:00 [entrez]
AID - S0755-4982(05)84181-8 [pii]
AID - 10.1016/s0755-4982(05)84181-8 [doi]
PST - ppublish
SO  - Presse Med. 2005 Oct 22;34(18):1325-9. doi: 10.1016/s0755-4982(05)84181-8.