PMID- 17560290
OWN - NLM
STAT- MEDLINE
DCOM- 20070817
LR  - 20181201
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 49
IP  - 23
DP  - 2007 Jun 12
TI  - Efficacy and safety of enoxaparin versus unfractionated heparin in patients with 
      ST-segment elevation myocardial infarction also treated with clopidogrel.
PG  - 2256-63
AB  - OBJECTIVES: The purpose of this study was to determine the efficacy and safety of 
      enoxaparin (ENOX) versus unfractionated heparin (UFH) in patients with ST-segment 
      elevation myocardial infarction (STEMI) receiving fibrinolytic therapy with and 
      without clopidogrel. BACKGROUND: The efficacy and safety of ENOX and clopidogrel 
      given together in STEMI remains to be defined. METHODS: We compared the rates of 
      major adverse cardiovascular events (MACE) as well as the rates of bleeding in 
      medically managed patients randomized to ENOX versus UFH in the ExTRACT-TIMI 25 
      (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction 
      Treatment-Thrombolysis In Myocardial Infarction 25) trial, stratified by 
      concomitant clopidogrel use. RESULTS: Enoxaparin significantly reduced the rate 
      of the composite of death, recurrent myocardial infarction, myocardial ischemia, 
      or stroke, compared with UFH, both in patients (n = 2,173) treated with 
      clopidogrel (10.8% vs. 13.9%, adjusted odds ratio [OR(adj)] 0.70, p = 0.013) and 
      in patients (n = 12,918) not treated with clopidogrel (13.3% vs. 15.3%, OR(adj) 
      0.85, p = 0.003) with no evidence of heterogeneity (p(interaction) = 0.21). The 
      excess risk of TIMI major bleeding with ENOX versus UFH was numerically but not 
      statistically significantly higher in patients treated with clopidogrel (2.7% vs. 
      1.0%) versus those who were not (2.1% vs. 1.2%) (p(interaction) = 0.61). Net 
      clinical benefit (MACE and major bleeding) favored treatment with ENOX over UFH, 
      either with concomitant clopidogrel (absolute risk reduction 2.4%, 95% confidence 
      interval [CI] -0.5% to 5.3%) or without (absolute risk reduction 1.7%, 95% CI 
      0.5% to 3.0%) (p(interaction) = 0.61). CONCLUSIONS: In patients with STEMI 
      receiving fibrinolytic therapy, the net benefit of ENOX is similar in patients 
      who are and are not treated with clopidogrel. The totality of trial data suggest 
      that the combination of a fibrinolytic, aspirin, clopidogrel, and ENOX offers an 
      attractive pharmacologic reperfusion strategy in STEMI.
FAU - Sabatine, Marc S
AU  - Sabatine MS
AD  - Thrombolysis In Myocardial Infarction (TIMI) Study Group, Cardiovascular 
      Division, Brigham and Women's Hospital and Department of Medicine, Harvard 
      Medical School, Boston, Massachusetts 02115, USA.
FAU - Morrow, David A
AU  - Morrow DA
FAU - Dalby, Anthony
AU  - Dalby A
FAU - Pfisterer, Mathias
AU  - Pfisterer M
FAU - Duris, Tibor
AU  - Duris T
FAU - Lopez-Sendon, Jose
AU  - Lopez-Sendon J
FAU - Murphy, Sabina A
AU  - Murphy SA
FAU - Gao, Runlin
AU  - Gao R
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Braunwald, Eugene
AU  - Braunwald E
CN  - ExTRACT-TIMI 25 Investigators
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20070525
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Aged
MH  - Clopidogrel
MH  - Double-Blind Method
MH  - Drug Therapy, Combination
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Thrombolytic Therapy
MH  - Ticlopidine/*analogs & derivatives/therapeutic use
MH  - Treatment Outcome
EDAT- 2007/06/15 09:00
MHDA- 2007/08/19 09:00
CRDT- 2007/06/15 09:00
PHST- 2006/09/07 00:00 [received]
PHST- 2006/12/21 00:00 [revised]
PHST- 2007/01/02 00:00 [accepted]
PHST- 2007/06/15 09:00 [pubmed]
PHST- 2007/08/19 09:00 [medline]
PHST- 2007/06/15 09:00 [entrez]
AID - S0735-1097(07)01069-8 [pii]
AID - 10.1016/j.jacc.2007.01.092 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Jun 12;49(23):2256-63. doi: 10.1016/j.jacc.2007.01.092. 
      Epub 2007 May 25.