PMID- 18035079
OWN - NLM
STAT- MEDLINE
DCOM- 20071203
LR  - 20071123
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 154
IP  - 6
DP  - 2007 Dec
TI  - Adjunctive benefits from low-molecular-weight heparins as compared to 
      unfractionated heparin among patients with ST-segment elevation myocardial 
      infarction treated with thrombolysis. A meta-analysis of the randomized trials.
PG  - 1085.e1-6
AB  - BACKGROUND: Improvement in adjunctive antithrombotic therapy is a key point in 
      pharmacologic reperfusion for ST-segment elevation myocardial infarction (STEMI). 
      The aim of the current study was to perform an updated meta-analysis of all 
      randomized trials comparing low-molecular-weight heparins (LMWHs) versus 
      unfractionated heparin (UFH) in patients with STEMI treated with thrombolysis. 
      METHODS: We obtained results from all randomized trials comparing LMWHs versus 
      UFH among patients with STEMI treated with thrombolysis. The literature was 
      scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from 
      January 1990 to June 2007. The following keywords were used: randomized trial, 
      myocardial infarction, reperfusion, thrombolysis, duteplase, reteplase, 
      tenecteplase, alteplase, UFH, LMWHs, dalteparin, nadroparin, enoxaparin, 
      reviparin, parnaparin. Clinical end points assessed were mortality and 
      reinfarction at 30-day follow-up, whereas major bleeding complications were 
      assessed as safety end point. The relationship between mortality benefits from 
      LMWHs and patient's risk profile was evaluated by using a weighted least-square 
      regression in which results from each trial were weighted by the square root of 
      the number of patients in each trial. No language restriction was applied. 
      RESULTS: We identified a total of 8 randomized trials, including 13,940 patients 
      randomized to LMWHs and 13,818 to UFH. Low-molecular-weight heparins were 
      associated with a trend in reduction in mortality (6.6% vs 7.2%, odds ratio [OR] 
      0.92, 95% CI 0.84-1.01, P = .08, P heterogeneity [P het] = 0.7) and significant 
      reduction in reinfarction (3.2% vs 4.8%, OR 0.65, 95% CI 0.58-0.64, P < .0001, P 
      het = 0.39), but a higher risk of major bleeding complications (2.4% vs 1.8%, OR 
      1.37, 95% CI 1.16-1.61, P < .001, P het = 0.32). CONCLUSIONS: Among patients with 
      STEMI treated with thrombolysis, LMWHs, as compared to UFH, are associated with a 
      trend in mortality benefits and a significant reduction in reinfarction (reMI) at 
      30-day follow-up, but with higher risk of major bleeding complications. In view 
      of the additional practical advantages, such as reduced interindividual 
      variability in therapeutic response and no need for frequent activated partial 
      thromboplastin time (aPTT) monitoring and dose adjustment, LMWHs should be 
      considered, instead of UFH, among patients with STEMI treated with thrombolysis.
FAU - De Luca, Giuseppe
AU  - De Luca G
AD  - Division of Cardiology, Maggiore della Carita Hospital, Eastern Piedmont 
      University A. Avogadro, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
FAU - Marino, Paolo
AU  - Marino P
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20071026
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Drug Therapy, Combination
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - *Thrombolytic Therapy
EDAT- 2007/11/24 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/11/24 09:00
PHST- 2007/07/26 00:00 [received]
PHST- 2007/08/23 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)00765-X [pii]
AID - 10.1016/j.ahj.2007.08.029 [doi]
PST - ppublish
SO  - Am Heart J. 2007 Dec;154(6):1085.e1-6. doi: 10.1016/j.ahj.2007.08.029. Epub 2007 
      Oct 26.