PMID- 16291601
OWN - NLM
STAT- MEDLINE
DCOM- 20060221
LR  - 20181203
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 112
IP  - 25
DP  - 2005 Dec 20
TI  - Angiographic and clinical outcomes in patients receiving low-molecular-weight 
      heparin versus unfractionated heparin in ST-elevation myocardial infarction 
      treated with fibrinolytics in the CLARITY-TIMI 28 Trial.
PG  - 3846-54
AB  - BACKGROUND: Low-molecular-weight heparin (LMWH) offers pharmacological and 
      practical advantages over unfractionated heparin (UFH). Whether these advantages 
      translate into greater infarct-related artery patency and fewer adverse clinical 
      events in patients with ST-elevation myocardial infarction (STEMI) receiving 
      fibrinolytic therapy remains under study. METHODS AND RESULTS: We compared 
      angiographic and clinical outcomes in patients treated with LMWH (n=1429) versus 
      UFH (n=1431) in CLARITY-TIMI 28, a randomized trial of clopidogrel versus placebo 
      in STEMI patients aged 18 to 75 years undergoing fibrinolysis. After 
      comprehensive adjustment for baseline characteristics, therapeutic interventions, 
      and a propensity score, treatment with LMWH was associated with a significantly 
      lower rate of a closed infarct-related artery or death or myocardial infarction 
      before angiography (13.5% versus 22.5%, adjusted OR 0.76, P=0.027). Treatment 
      with LMWH was also associated with a significantly lower rate of cardiovascular 
      death or recurrent myocardial infarction through 30 days (6.9% versus 11.5%, 
      adjusted OR 0.68, P=0.030). The lower event rates were observed in patients 
      allocated to clopidogrel and in those who underwent percutaneous coronary 
      intervention. Rates of TIMI major bleeding through 30 days (1.6% versus 2.2%, 
      P=0.27) and intracranial hemorrhage (0.6% versus 0.8%, P=0.37) were similar in 
      the LMWH and UFH groups. Patients who received both clopidogrel and LMWH, in 
      addition to a standard fibrinolytic and aspirin, had a particularly high rate of 
      infarct-related artery patency (90.9%) and particularly low rates of 
      cardiovascular death (3.2%), recurrent myocardial infarction (3.0%), and major 
      bleeding (1.8%). CONCLUSIONS: In patients with STEMI receiving fibrinolytic 
      therapy, use of LMWH with other standard therapies, including clopidogrel and 
      aspirin, is associated with improved angiographic outcomes and lower rates of 
      major adverse cardiovascular events.
FAU - Sabatine, Marc S
AU  - Sabatine MS
AD  - Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular 
      Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical 
      School, Boston, Massachusetts, USA. msabatine@partners.org
FAU - Morrow, David A
AU  - Morrow DA
FAU - Montalescot, Gilles
AU  - Montalescot G
FAU - Dellborg, Mikael
AU  - Dellborg M
FAU - Leiva-Pons, Jose L
AU  - Leiva-Pons JL
FAU - Keltai, Matyas
AU  - Keltai M
FAU - Murphy, Sabina A
AU  - Murphy SA
FAU - McCabe, Carolyn H
AU  - McCabe CH
FAU - Gibson, C Michael
AU  - Gibson CM
FAU - Cannon, Christopher P
AU  - Cannon CP
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Braunwald, Eugene
AU  - Braunwald E
CN  - Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)-Thrombolysis in 
      Myocardial Infarction (TIMI) 28 Investigators
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20051115
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aspirin/therapeutic use
MH  - Clopidogrel
MH  - Coronary Angiography
MH  - Coronary Thrombosis/prevention & control
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/toxicity
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/toxicity
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/*drug therapy/mortality/physiopathology
MH  - Myocardial Reperfusion
MH  - Secondary Prevention
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Treatment Outcome
MH  - Vascular Patency/drug effects
EDAT- 2005/11/18 09:00
MHDA- 2006/02/24 09:00
CRDT- 2005/11/18 09:00
PHST- 2005/11/18 09:00 [pubmed]
PHST- 2006/02/24 09:00 [medline]
PHST- 2005/11/18 09:00 [entrez]
AID - CIRCULATIONAHA.105.595397 [pii]
AID - 10.1161/CIRCULATIONAHA.105.595397 [doi]
PST - ppublish
SO  - Circulation. 2005 Dec 20;112(25):3846-54. doi: 10.1161/CIRCULATIONAHA.105.595397. 
      Epub 2005 Nov 15.