PMID- 17163268
OWN - NLM
STAT- MEDLINE
DCOM- 20070316
LR  - 20181113
IS  - 1173-2563 (Print)
IS  - 1173-2563 (Linking)
VI  - 26
IP  - 6
DP  - 2006
TI  - Use of unfractionated heparin and a low-molecular-weight heparin following 
      thrombolytic therapy for acute ST-segment elevation myocardial infarction.
PG  - 341-9
AB  - BACKGROUND: Acute myocardial infarction (AMI) is one of the most serious 
      cardiovascular diseases, with acute ST-segment elevation myocardial infarction 
      (STEMI) showing a higher mortality rate than non-ST-segment elevation myocardial 
      infarction (NSTEMI). There is evidence that low-molecular-weight heparin (LMWH) 
      shows greater efficacy than unfractionated heparin (UFH). This open-label, 
      single-centre, randomised study was conducted to compare the efficacy and safety 
      of parnaparin sodium, a LMWH, with UFH in patients with STEMI. PATIENTS AND 
      METHODS: Patients with STEMI were randomised to receive either parnaparin sodium 
      (4250IU aXa subcutaneously every 12 hours for 7 days, initiated 12 hours after 
      thrombolysis) or UFH (100 U/kg intravenous bolus, initiated 12 hours after 
      thrombolytic therapy, followed by 1000 U/hour as a continuous infusion for 3 
      days, then 7500U subcutaneously every 12 hours for 4 days). Patients were 
      followed up for 45 days (> or =14 days in hospital). RESULTS: In total, 186 
      patients were randomised to receive parnaparin sodium (n = 96) or UFH (n = 90). A 
      significantly greater reduction in the composite primary endpoint (sum of all 
      deaths, first occurrence of recurrent MI, and first occurrence of emergency 
      revascularisation) was seen with parnaparin sodium compared with UFH at day 45 
      (27.08% vs 42.22%; p = 0.03). A lower incidence of composite endpoint was seen as 
      early as day 2 with parnaparin sodium, but this did not reach significance versus 
      UFH. The rate of individual endpoint events (death, first occurrence of non-fatal 
      recurrent MI and first occurrence of emergency revascularisation) was lower in 
      the parnaparin sodium group than the UFH group at 2, 7, 14 and 45 days, but the 
      differences were not statistically significant. At day 7, the incidences of any 
      bleeding and heparin-induced thrombocytopenia were also lower in the parnaparin 
      sodium group compared with the UFH group (3.13% vs 10.0%; p = 0.06 and 0% vs 
      3.33%; p = 0.07, respectively). CONCLUSION: The results of this study indicate 
      that parnaparin sodium is more effective than UFH in reducing composite cardiac 
      events in patients with STEMI following thrombolytic therapy. There was also a 
      lower incidence of bleeding and heparin-induced thrombocytopenia with parnaparin 
      sodium than with UFH. In view of these findings, parnaparin sodium represents an 
      effective, convenient and well tolerated alternative to UFH.
FAU - Wang, Xu-Kai
AU  - Wang XK
AD  - Daping Hospital, Third Military Medical University, Chongqing, China. 
      wangxuk@163.com
FAU - Zhang, Ye
AU  - Zhang Y
FAU - Yang, Cheng-Ming
AU  - Yang CM
FAU - Wang, Yan
AU  - Wang Y
FAU - Liu, Guang-Yao
AU  - Liu GY
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Clin Drug Investig
JT  - Clinical drug investigation
JID - 9504817
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - M316WT19D8 (parnaparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Aspirin/administration & dosage/adverse effects/therapeutic use
MH  - Blood Coagulation/drug effects
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Female
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  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy/physiopathology
MH  - Partial Thromboplastin Time/methods
MH  - Platelet Count/methods
MH  - Thrombocytopenia/chemically induced
MH  - *Thrombolytic Therapy
MH  - Time Factors
MH  - Tomography Scanners, X-Ray Computed
MH  - Treatment Outcome
EDAT- 2006/12/14 09:00
MHDA- 2007/03/17 09:00
CRDT- 2006/12/14 09:00
PHST- 2006/12/14 09:00 [pubmed]
PHST- 2007/03/17 09:00 [medline]
PHST- 2006/12/14 09:00 [entrez]
AID - 2665 [pii]
AID - 10.2165/00044011-200626060-00005 [doi]
PST - ppublish
SO  - Clin Drug Investig. 2006;26(6):341-9. doi: 10.2165/00044011-200626060-00005.