PMID- 17562672
OWN - NLM
STAT- MEDLINE
DCOM- 20071109
LR  - 20080410
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 28
IP  - 13
DP  - 2007 Jul
TI  - Enoxaparin is superior to unfractionated heparin in patients with ST elevation 
      myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: 
      an ExTRACT-TIMI 25 analysis.
PG  - 1566-73
AB  - AIMS: We compared outcomes of ST-elevation myocardial infarction (STEMI) patients 
      randomized to a strategy of either enoxaparin or unfractionated heparin (UFH) to 
      support fibrinolysis. METHODS AND RESULTS: In the Enoxaparin and Thrombolysis 
      Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis in Myocardial 
      Infarction Study 25 (ExTRACT-TIMI 25) trial, 20,479 patients undergoing 
      fibrinolysis for STEMI with a fibrin-specific agent (N = 16,283) or streptokinase 
      (SK) (N = 4139) were randomized to enoxaparin throughout their hospitalization or 
      UFH for at least 48 h. The primary end point of death or nonfatal recurrent MI 
      through 30 days occurred in 12.0% of patients in the UFH and 9.8% in the 
      enoxaparin groups when treated with fibrin-specific lytics [odds ratio(adjusted) 
      (OR(adj)) 0.78; 95% CI 0.70-0.87; P < 0.001] and 11.8 vs. 10.2%, respectively, 
      when treated with SK (OR(adj) 0.83; 95% CI 0.66-1.04; P = 0.10; P(interaction) = 
      0.58). Major bleeding rates including intracranial hemorrhage within the 
      fibrin-specific cohort were 1.2 and 2.0% in the UFH and enoxaparin groups, 
      respectively (P < 0.001) and 2.0% in UFH and 2.4% in enoxaparin patients in the 
      SK cohort (P = 0.16). Interaction tests between antithrombin- and lytic-type were 
      non-significant (P = 0.20). Death, nonfatal MI, or major bleeding was 
      significantly reduced with enoxaparin in the fibrin-specific cohort (OR(adj) 
      0.82; 95% CI 0.74-0.91; P < 0.001) and favoured enoxaparin in the SK cohort 
      (OR(adj) 0.89; 95% CI 0.72-1.10; P = 0.29; P(interaction) = 0.53). CONCLUSION: 
      The benefits of an enoxaparin strategy over UFH were observed in both SK and 
      fibrin-specific-treated STEMI patients. Therefore, an enoxaparin strategy is 
      preferred over UFH to support fibrinolysis for STEMI regardless of lytic agent.
FAU - Giraldez, Roberto R
AU  - Giraldez RR
AD  - TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and 
      Women's Hospital, Harvard Medical School, 350 Longwood Avenue, 1st Floor, Boston, 
      MA 02115, USA. rgiraldez@partners.org
FAU - Nicolau, Jose Carlos
AU  - Nicolau JC
FAU - Corbalan, Ramon
AU  - Corbalan R
FAU - Gurfinkel, Enrique P
AU  - Gurfinkel EP
FAU - Juarez, Ursulo
AU  - Juarez U
FAU - Lopez-Sendon, Jose
AU  - Lopez-Sendon J
FAU - Parkhomenko, Alexander
AU  - Parkhomenko A
FAU - Molhoek, Peter
AU  - Molhoek P
FAU - Mohanavelu, Satishkumar
AU  - Mohanavelu S
FAU - Morrow, David A
AU  - Morrow DA
FAU - Antman, Elliott M
AU  - Antman EM
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20070611
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Eur Heart J. 2007 Dec;28(23):2952; author reply 2952-3. PMID: 17965415
CIN - ACP J Club. 2007 Nov-Dec;147(3):63. PMID: 17975865
MH  - Aged
MH  - Decision Making
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/therapeutic use
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*drug therapy
MH  - Myocardial Reperfusion/methods
MH  - Treatment Outcome
EDAT- 2007/06/15 09:00
MHDA- 2007/11/10 09:00
CRDT- 2007/06/15 09:00
PHST- 2007/06/15 09:00 [pubmed]
PHST- 2007/11/10 09:00 [medline]
PHST- 2007/06/15 09:00 [entrez]
AID - ehm179 [pii]
AID - 10.1093/eurheartj/ehm179 [doi]
PST - ppublish
SO  - Eur Heart J. 2007 Jul;28(13):1566-73. doi: 10.1093/eurheartj/ehm179. Epub 2007 
      Jun 11.