PMID- 19634922
OWN - NLM
STAT- MEDLINE
DCOM- 20091030
LR  - 20211020
IS  - 1179-1950 (Electronic)
IS  - 0012-6667 (Linking)
VI  - 69
IP  - 11
DP  - 2009 Jul 30
TI  - Streptokinase and enoxaparin as an alternative to fibrin-specific lytic-based 
      regimens: an ExTRACT-TIMI 25 analysis.
PG  - 1433-43
LID - 10.2165/00003495-200969110-00003 [doi]
AB  - BACKGROUND: Enoxaparin was superior to unfractionated heparin (UFH), regardless 
      of fibrinolytic agent in ST-elevation myocardial infarction (STEMI) patients 
      receiving fibrinolytic therapy in ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis 
      Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in 
      Myocardial Infarction 25) trial. OBJECTIVE: This post hoc analysis compared 
      outcomes with streptokinase plus enoxaparin to the standard regimen of 
      fibrin-specific lytic (FSL) plus UFH and to the newer combination of FSL plus 
      enoxaparin. METHODS: In ExTRACT-TIMI 25, STEMI patients received either 
      streptokinase or a FSL (alteplase, reteplase or tenecteplase) at the physician's 
      discretion and were randomized to enoxaparin or UFH, stratified by fibrinolytic 
      type. Thirty-day outcomes were adjusted for baseline characteristics, region, 
      in-hospital percutaneous coronary intervention (PCI) and a propensity score for 
      the choice of lytic. RESULTS: The primary trial endpoint of 30-day 
      death/myocardial infarction (MI) occurred in fewer patients in the 
      streptokinase-enoxaparin cohort (n = 2083) compared with FSL-UFH (n = 8141) 
      [10.2% vs 12.0%, adjusted odds ratio [OR(adj)] 0.76; 95% CI 0.62, 0.93; p = 
      0.008]. Major bleeding was significantly increased with streptokinase-enoxaparin 
      compared with FSL-UFH (OR(adj) 2.74; 95% CI 1.81; 4.14; p < 0.001) but 
      intracranial haemorrhage (ICH) was similar (OR(adj) 0.90; 95% CI 0.40, 2.01; p = 
      0.79). Net clinical outcomes, defined as either death/MI/major bleeding or as 
      death/MI/ICH tended to favour streptokinase-enoxaparin compared with FSL-UFH 
      (OR(adj) 0.88; 95% CI 0.73, 1.06; p = 0.17; and OR(adj) 0.77; 95% CI 0.63, 0.93; 
      p = 0.008, respectively). Patients receiving FSL-enoxaparin (n = 8142) and 
      streptokinase-enoxaparin therapies experienced similar adjusted rates of the 
      primary endpoint (OR(adj) 1.08; 95% CI 0.87, 1.32; p = 0.49) and net clinical 
      outcomes. CONCLUSIONS: Our results suggest that fibrinolytic therapy with the 
      combination of streptokinase and the potent anticoagulant agent enoxaparin 
      resulted in similar adjusted outcomes compared with more costly regimens 
      utilizing a FSL.
FAU - Giraldez, Roberto R
AU  - Giraldez RR
AD  - TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and 
      Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
FAU - Wiviott, Stephen D
AU  - Wiviott SD
FAU - Nicolau, Jose C
AU  - Nicolau JC
FAU - Mohanavelu, Satishkumar
AU  - Mohanavelu S
FAU - Morrow, David A
AU  - Morrow DA
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Giugliano, Robert P
AU  - Giugliano RP
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Drugs
JT  - Drugs
JID - 7600076
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Recombinant Proteins)
RN  - 9001-31-4 (Fibrin)
RN  - DQA630RIE9 (reteplase)
RN  - EC 3.4.- (Streptokinase)
RN  - EC 3.4.21.- (Plasminogen Activators)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - WGD229O42W (Tenecteplase)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary
MH  - Cohort Studies
MH  - Drug Therapy, Combination
MH  - Endpoint Determination
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Fibrin/*drug effects
MH  - Fibrinolytic Agents/adverse effects/economics/*therapeutic use
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/prevention & control
MH  - Plasminogen Activators/economics/therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - Streptokinase/adverse effects/economics/*therapeutic use
MH  - Tenecteplase
MH  - *Thrombolytic Therapy
MH  - Time Factors
MH  - Tissue Plasminogen Activator/economics/therapeutic use
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2009/07/29 09:00
MHDA- 2009/10/31 06:00
CRDT- 2009/07/29 09:00
PHST- 2009/07/29 09:00 [entrez]
PHST- 2009/07/29 09:00 [pubmed]
PHST- 2009/10/31 06:00 [medline]
AID - 3 [pii]
AID - 10.2165/00003495-200969110-00003 [doi]
PST - ppublish
SO  - Drugs. 2009 Jul 30;69(11):1433-43. doi: 10.2165/00003495-200969110-00003.