PMID- 16864962
OWN - NLM
STAT- MEDLINE
DCOM- 20070226
LR  - 20171116
IS  - 1421-9751 (Electronic)
IS  - 0008-6312 (Linking)
VI  - 107
IP  - 2
DP  - 2007
TI  - Low-molecular-weight heparins in conjunction with thrombolysis for ST-elevation 
      acute myocardial infarction. A critical review of the literature.
PG  - 132-9
AB  - BACKGROUND: Intravenous unfractionated heparin (UFH) is recommended in 
      ST-elevation acute myocardial infarction (STEMI), following thrombolysis with 
      fibrin-specific agents. Subcutaneous low-molecular-weight heparins (LMWH), 
      previously proven effective in non-ST-elevation acute coronary syndromes, have 
      been recently investigated in the setting of STEMI. We aimed at evaluating the 
      current level of evidence supporting the use of LMWH in STEMI. METHODS: A Medline 
      search of the English language literature between January 1995 and December 2005 
      was performed and randomized clinical trials comparing LMWH to either placebo or 
      UFH in conjunction with thrombolysis were selected. RESULTS: About 26,800 
      patients treated with various thrombolytic regimens were included in 12 
      randomized clinical trials. Dalteparin was superior to placebo on left 
      ventricular thrombosis/arterial thromboembolism, with no significant effect on 
      the early patency rate of the infarct-related artery (IRA). Compared to UFH, 
      dalteparin had no significant effect on clinical events and on the IRA late 
      patency, although less thrombus was present. Enoxaparin was superior to placebo 
      on the medium-term death/reinfarction/angina rate and late IRA patency, and 
      superior also to UFH on in-hospital and medium-term occurrence of 
      death/reinfarction/angina. The effect of enoxaparin on IRA patency rate was not 
      univocal. Compared to placebo, reviparin significantly reduced early and 
      medium-term mortality and reinfarction rates, without a substantial increase in 
      overall stroke rate. As regards safety, bleedings were more frequent than placebo 
      and comparable to UFH in LMWH groups, with the exception of the pre-hospital 
      ASSENT-3 PLUS trial, where in elderly patients, enoxaparin had an incidence of 
      intracranial hemorrhage twice higher than UFH. CONCLUSIONS: In-hospital 
      subcutaneous administration of dalteparin, enoxaparin or reviparin, as an adjunct 
      to various thrombolytics in STEMI, appears feasible and at least as effective and 
      safe as intravenous UFH. Before LMWH might be recommended, however, some yet 
      unresolved issues (i.e. use in elderly patients, in severe renal insufficiency, 
      in association with glycoprotein IIb/IIIa inhibitors and during interventional 
      procedures), need to be addressed.
CI  - Copyright 2007 S. Karger AG, Basel.
FAU - Rubboli, Andrea
AU  - Rubboli A
AD  - Division of Cardiology, Maggiore Hospital, Bologna, Italy. 
      andrearubboli@libero.it
FAU - Ottani, Filippo
AU  - Ottani F
FAU - Capecchi, Alessandro
AU  - Capecchi A
FAU - Brancaleoni, Rossella
AU  - Brancaleoni R
FAU - Galvani, Marcello
AU  - Galvani M
FAU - Swahn, Ewa
AU  - Swahn E
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20060721
PL  - Switzerland
TA  - Cardiology
JT  - Cardiology
JID - 1266406
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5R0L1D739E (reviparin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Dalteparin/therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy
MH  - *Thrombolytic Therapy
RF  - 37
EDAT- 2006/07/26 09:00
MHDA- 2007/02/27 09:00
CRDT- 2006/07/26 09:00
PHST- 2005/07/04 00:00 [received]
PHST- 2006/05/18 00:00 [accepted]
PHST- 2006/07/26 09:00 [pubmed]
PHST- 2007/02/27 09:00 [medline]
PHST- 2006/07/26 09:00 [entrez]
AID - 94659 [pii]
AID - 10.1159/000094659 [doi]
PST - ppublish
SO  - Cardiology. 2007;107(2):132-9. doi: 10.1159/000094659. Epub 2006 Jul 21.