PMID- 19609890
OWN - NLM
STAT- MEDLINE
DCOM- 20100222
LR  - 20211020
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 32
IP  - 7
DP  - 2009 Jul
TI  - Adjunctive low molecular weight heparin during fibrinolytic therapy in acute 
      ST-segment elevation myocardial infarction: a meta-analysis of randomized control 
      trials.
PG  - 358-64
LID - 10.1002/clc.20432 [doi]
AB  - BACKGROUND: Recent data suggests that low molecular weight heparins (LMWHs) may 
      be superior to unfractionated heparin (UFH) as an adjunct to fibrinolytic therapy 
      in patients with acute ST-segment elevation myocardial infarction (STEMI). 
      HYPOTHESIS: We evaluated cardiac outcomes and the risk of major bleeding with 
      LMWHs vs UFH in the management of STEMI. METHODS: Seven randomized trials of 
      patients with acute STEMI treated with fibrinolytic therapy and adjunctive LMWHs 
      through the index hospitalization or weight-based UFH for at least 48 hours were 
      identified. We analyzed both primary endpoints (death and nonfatal recurrent 
      myocardial infarction through 30 days), and secondary endpoints (death, recurrent 
      myocardial infarction, and major bleeding during index hospitalization at 7 
      days). Outcomes were computed using the Mantel-Haenszel fixed-effect model. A 
      2-sided alpha error of < 0.05 was considered significant. RESULTS: Compared to 
      UFH, LMWH significantly reduced reinfarction (p < 0.001) during hospitalization 
      at 7 days and the effect remained consistent at 30 d (p < 0.001). When analyzed 
      for mortality at 7 days and 30 days follow-up, there were no statistically 
      significant differences observed between the 2 groups. Additionally the LMWH 
      group had higher risk of major bleeding (p < 0.001). CONCLUSIONS: The present 
      meta-analysis suggests in patients receiving fibrinolytic therapy for STEMI, 
      LMWHs as an adjunctive therapy is superior to UFH in reducing reinfarction during 
      hospitalization at 7 days and at 30 days. The mortality was not significant 
      between the 2 groups during hospitalization at 7 days and at 30 days. However, 
      UFH is superior to LMWHs in the reduction of major bleeding at 7 days index 
      hospitalization.
FAU - Singh, Sarabjeet
AU  - Singh S
AD  - Department of Medicine, Chicago Medical School, North Chicago, Illinois 60064, 
      USA. sarabjeetsingh_2000@yahoo.com
FAU - Bahekar, Amol
AU  - Bahekar A
FAU - Molnar, Janos
AU  - Molnar J
FAU - Khosla, Sandeep
AU  - Khosla S
FAU - Arora, Rohit
AU  - Arora R
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Drug Therapy, Combination
MH  - Evidence-Based Medicine
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Hospitalization
MH  - Humans
MH  - Length of Stay
MH  - Myocardial Infarction/*drug therapy/mortality
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Recurrence
MH  - Risk Assessment
MH  - *Thrombolytic Therapy/adverse effects/mortality
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC6653358
EDAT- 2009/07/18 09:00
MHDA- 2010/02/23 06:00
PMCR- 2009/07/16
CRDT- 2009/07/18 09:00
PHST- 2009/07/18 09:00 [entrez]
PHST- 2009/07/18 09:00 [pubmed]
PHST- 2010/02/23 06:00 [medline]
PHST- 2009/07/16 00:00 [pmc-release]
AID - CLC20432 [pii]
AID - 10.1002/clc.20432 [doi]
PST - ppublish
SO  - Clin Cardiol. 2009 Jul;32(7):358-64. doi: 10.1002/clc.20432.