PMID- 19924279
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20110714
LR  - 20211020
IS  - 1875-6557 (Electronic)
IS  - 1573-403X (Print)
IS  - 1573-403X (Linking)
VI  - 4
IP  - 1
DP  - 2008 Feb
TI  - Efficacy and Safety of Low-Molecular-Weight Heparins As An Adjunct to 
      Thrombolysis in Acute ST-Elevation Myocardial Infarction.
PG  - 63-71
LID - 10.2174/157340308783565438 [doi]
AB  - A 48-hour course of intravenous unfractionated heparin (UFH) is the standard of 
      treatment in conjunction with fibrin-specific thrombolysis in ST-elevation 
      myocardial infarction (STEMI). In recent trials, the efficacy and safety of 
      in-hospital administration of subcutaneous low-molecular-weight heparins (LMWH), 
      previously proven effective in non-ST-elevation acute coronary syndromes, have 
      been investigated in the setting of STEMI. The aim of this review was to evaluate 
      the available evidence supporting the use of LMWH in STEMI.Overall, about 27,000 
      patients treated with various thrombolytic regimens, were included in 12 
      open-label randomized clinical trials, where dalteparin, reviparin or enoxaparin 
      were administered. While acknowledging the wide variability in study dimensions, 
      designs and end-points, a higher efficacy of LMWH was observed overall as 
      compared to placebo, and also to UFH (mainly as regards the occurrence of 
      reinfarction). As regards safety, bleedings were more frequent than placebo and 
      comparable to UFH in LMWH groups, with the exception of the pre-hospital ASSENT-3 
      PLUS trial, where in elderly patients, enoxaparin had an incidence of 
      intracranial hemorrhage twice higher than UFH. In a recent double-blind, 
      randomized, mega-trial including over 20,000 patients, the superior efficacy on 
      in-hospital and 30-day adverse cardiac events (namely reinfarction), and 
      comparable safety on intracranial bleedings, of enoxaparin compared to UFH, was 
      shown.In conclusion, in-hospital subcutaneous administration of dalteparin, 
      reviparin and enoxaparin, as an adjunct to various thrombolytics in STEMI, 
      appears feasible and at least as effective and safe as 48-hour intravenous 
      treatment with UFH. In accordance with the available strongest evidence, an 
      initial intravenous bolus of enoxaparin followed by twice daily subcutaneous 
      administration for about 1 week should be the preferred regimen, and should be 
      strongly considered instead of intravenous UFH. Along with its easiness of use, 
      not requiring laboratory monitoring, subcutaneous administration of LMWH 
      following STEMI treated with thrombolysis allows extended antithrombotic 
      treatment, while permitting early mobilization (and rehabilitation) of patients.
FAU - Rubboli, Andrea
AU  - Rubboli A
AD  - Cardiac Catheterization Laboratory, Division of Cardiology, Maggiore Hospital, 
      Bologna, Italy.
LA  - eng
PT  - Journal Article
PL  - United Arab Emirates
TA  - Curr Cardiol Rev
JT  - Current cardiology reviews
JID - 101261935
PMC - PMC2774587
OTO - NOTNLM
OT  - ST-elevation acute myocardial infarction
OT  - dalteparin
OT  - enoxaparin
OT  - reviparin
OT  - unfractionated heparin.
EDAT- 2008/02/01 00:00
MHDA- 2008/02/01 00:01
PMCR- 2009/02/01
CRDT- 2009/11/20 06:00
PHST- 2007/01/29 00:00 [received]
PHST- 2007/12/14 00:00 [revised]
PHST- 2007/12/18 00:00 [accepted]
PHST- 2009/11/20 06:00 [entrez]
PHST- 2008/02/01 00:00 [pubmed]
PHST- 2008/02/01 00:01 [medline]
PHST- 2009/02/01 00:00 [pmc-release]
AID - CCR-4-63 [pii]
AID - 10.2174/157340308783565438 [doi]
PST - ppublish
SO  - Curr Cardiol Rev. 2008 Feb;4(1):63-71. doi: 10.2174/157340308783565438.