PMID- 16344381
OWN - NLM
STAT- MEDLINE
DCOM- 20060221
LR  - 20141120
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 112
IP  - 25
DP  - 2005 Dec 20
TI  - Unfractionated and low-molecular-weight heparin as adjuncts to thrombolysis in 
      aspirin-treated patients with ST-elevation acute myocardial infarction: a 
      meta-analysis of the randomized trials.
PG  - 3855-67
AB  - BACKGROUND: There is uncertainty about the role of intravenous unfractionated 
      heparin (UFH) and low-molecular-weight heparin (LMWH) in patients with 
      ST-elevation myocardial infarction (STEMI) treated with aspirin and thrombolysis. 
      METHODS AND RESULTS: We performed a meta-analysis of the randomized trials to 
      assess the effect of UFH and LMWH on reinfarction, death, stroke, and bleeding. 
      Fourteen trials involving a total of 25,280 patients were included (1239 
      comparing intravenous UFH versus placebo or no heparin; 16,943 comparing LMWH 
      versus placebo; and 7098 comparing LMWH versus intravenous UFH). Intravenous UFH 
      during hospitalization did not reduce reinfarction (3.5% versus 3.3%; odds ratio 
      [OR], 1.08; 95% CI, 0.58 to 1.99) or death (4.8% versus 4.6%; OR, 1.04; 95% CI, 
      0.62 to 1.78) and did not increase major bleeding (4.2% versus 3.4%; OR, 1.21; 
      95% CI, 0.67 to 2.18) but increased minor bleeding (19.6% versus 12.5%; OR, 1.72; 
      95% CI, 1.22 to 2.43). During hospitalization/at 7 days, LMWH compared with 
      placebo reduced the risk of reinfarction by approximately one quarter (1.6% 
      versus 2.2%; OR, 0.72; 95% CI, 0.58 to 0.90; number needed to treat [NNT]=167) 
      and death by &10% (7.8% versus 8.7%; OR, 0.90; 95% CI, 0.80 to 0.99; NNT=111) but 
      increased major bleeding (1.1% versus 0.4%; OR, 2.70; 95% CI, 1.83 to 3.99; 
      number needed to harm [NNH]=143) and intracranial bleeding (0.3% versus 0.1%; OR, 
      2.18; 95% CI, 1.07 to 4.52; NNH=500). The reduction in death with LMWH remained 
      evident at 30 days. LMWH compared with UFH during hospitalization/at 7 days 
      reduced reinfarction by &45% (3.0% versus 5.2%; OR, 0.57; 95% CI, 0.45 to 0.73; 
      NNT=45), did not reduce death (4.8% versus 5.3%; OR, 0.92; 95% CI, 0.74 to 1.13) 
      or increase major bleeding (3.3% versus 2.5%; OR, 1.30; 95% CI, 0.98 to 1.72), 
      but increased minor bleeding (22.8% vs 19.4%; OR, 1.26; 95% CI, 1.12 to 1.43). 
      The reduction in reinfarction remained evident at 30 days. CONCLUSIONS: In 
      aspirin-treated patients with STEMI who are treated with thrombolysis, 
      intravenous UFH has not been shown to prevent reinfarction or death. LMWH given 
      for 4 to 8 days compared with placebo reduces reinfarction by approximately one 
      quarter and death by &10% and when directly compared with UFH reduces 
      reinfarction by almost one half. These data suggest that LMWH should be the 
      preferred antithrombin in this setting.
FAU - Eikelboom, John W
AU  - Eikelboom JW
AD  - General Division, Hamilton Health Sciences, Hamilton, Ontario, Canada.
FAU - Quinlan, Daniel J
AU  - Quinlan DJ
FAU - Mehta, Shamir R
AU  - Mehta SR
FAU - Turpie, Alexander G
AU  - Turpie AG
FAU - Menown, Ian B
AU  - Menown IB
FAU - Yusuf, Salim
AU  - Yusuf S
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20051212
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - ACP J Club. 2006 Jul-Aug;145(1):9. PMID: 16813357
MH  - Aspirin/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - Randomized Controlled Trials as Topic
MH  - Secondary Prevention
MH  - Survival Rate
MH  - *Thrombolytic Therapy
MH  - Treatment Outcome
EDAT- 2005/12/14 09:00
MHDA- 2006/02/24 09:00
CRDT- 2005/12/14 09:00
PHST- 2005/12/14 09:00 [pubmed]
PHST- 2006/02/24 09:00 [medline]
PHST- 2005/12/14 09:00 [entrez]
AID - CIRCULATIONAHA.105.573550 [pii]
AID - 10.1161/CIRCULATIONAHA.105.573550 [doi]
PST - ppublish
SO  - Circulation. 2005 Dec 20;112(25):3855-67. doi: 10.1161/CIRCULATIONAHA.105.573550. 
      Epub 2005 Dec 12.