PMID- 18035078
OWN - NLM
STAT- MEDLINE
DCOM- 20071203
LR  - 20131121
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 154
IP  - 6
DP  - 2007 Dec
TI  - Effect of enoxaparin versus unfractionated heparin in diabetic patients with 
      ST-elevation myocardial infarction in the Enoxaparin and Thrombolysis Reperfusion 
      for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 
      study 25 (ExTRACT-TIMI 25) trial.
PG  - 1078-84, 1084.e1
AB  - BACKGROUND: Patients with diabetes mellitus (DM) are at higher risk for 
      complications after ST-elevation myocardial infarction (STEMI) than patients 
      without DM. Potent antithrombotic therapies may offer particular benefit for 
      these high-risk patients and must be balanced against the potential for increased 
      bleeding. METHODS: We performed a prospectively planned analysis of efficacy and 
      safety in patients with DM among 20,479 patients with STEMI treated with 
      fibrinolysis and randomized to a strategy of enoxaparin (up to 8 days) or 
      unfractionated heparin (UFH) (48 hours) in ExTRACT-TIMI 25. RESULTS: Patients 
      with DM (n = 3060) were older and more likely to be women and to present with 
      heart failure (P < .0001 for each) than those without DM. After adjustment for 
      the TIMI Risk Score, sex, and renal function, patients with DM were at 30% higher 
      risk for death or myocardial infarction (MI) by 30 days (OR(adj) 1.29, 95% CI 
      1.14-1.46). Among patients with DM, the enoxaparin strategy reduced mortality 
      (9.5% vs 11.8%, relative risk [RR] 0.81, 95% CI 0.66-0.99), death/MI (13.6% vs 
      17.1%, RR 0.80; 95% CI 0.67-0.94), and death/MI/urgent revascularization (16.0% 
      vs 19.7%, RR 0.81, 95% CI 0.70-0.94). The enoxaparin strategy was associated with 
      a trend toward higher major bleeding (2.6% vs 1.6%, RR 1.63, 95% CI 0.99-2.69). 
      Taking efficacy and safety into account, the enoxaparin strategy offered superior 
      net clinical benefit (death/MI/major bleed, 14.8% vs 18.0%, RR 0.83, 95% CI 
      0.70-0.97) compared with UFH in patients with DM. CONCLUSIONS: In a subgroup 
      analysis, a reperfusion strategy including enoxaparin significantly improved 
      outcomes compared with UFH among high-risk STEMI patients with DM undergoing 
      fibrinolysis.
FAU - Morrow, David A
AU  - Morrow DA
AD  - Department of Medicine, Harvard Medical School, Boston, MA, USA. 
      dmorrow@partners.org
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Murphy, Sabina A
AU  - Murphy SA
FAU - Qin, Jie
AU  - Qin J
FAU - Ruda, Mikhail
AU  - Ruda M
FAU - Guneri, Sema
AU  - Guneri S
FAU - Jacob, Ashok Joseph
AU  - Jacob AJ
FAU - Budaj, Andrzej
AU  - Budaj A
FAU - Braunwald, Eugene
AU  - Braunwald E
CN  - TIMI Study Group
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Aspirin/therapeutic use
MH  - Diabetes Complications/*drug therapy
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/complications/*drug therapy
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
EDAT- 2007/11/24 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/11/24 09:00
PHST- 2007/01/31 00:00 [received]
PHST- 2007/07/23 00:00 [accepted]
PHST- 2007/11/24 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/11/24 09:00 [entrez]
AID - S0002-8703(07)00610-2 [pii]
AID - 10.1016/j.ahj.2007.07.027 [doi]
PST - ppublish
SO  - Am Heart J. 2007 Dec;154(6):1078-84, 1084.e1. doi: 10.1016/j.ahj.2007.07.027.