PMID- 21777368
OWN - NLM
STAT- MEDLINE
DCOM- 20120210
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 9
IP  - 10
DP  - 2011 Oct
TI  - Low-molecular-weight heparins vs. unfractionated heparin in the setting of 
      percutaneous coronary intervention for ST-elevation myocardial infarction: a 
      meta-analysis.
PG  - 1902-15
LID - 10.1111/j.1538-7836.2011.04445.x [doi]
AB  - BACKGROUND: The aim of the current study was to perform two separate 
      meta-analyses of available studies comparing low-molecular-weight heparins 
      (LMWHs) vs. unfractionated heparin (UFH) in ST-elevation myocardial infarction 
      (STEMI) patients treated (i) with primary percutaneous coronary intervention 
      (pPCI) or (ii) with PCI after thrombolysis. METHODS: All-cause mortality was the 
      pre-specified primary endpoint and major bleeding complications were recorded as 
      the secondary endpoints. Relative risk (RR) with a 95% confidence interval (CI) 
      and absolute risk reduction (ARR) were chosen as the effect measure. RESULTS: Ten 
      studies comprising 16,286 patients were included. The median follow-up was 2 
      months for the primary endpoint. Among LMWHs, enoxaparin was the compound most 
      frequently used. In the pPCI group, LMWHs were associated with a reduction in 
      mortality [RR (95% CI) = 0.51 (0.41-0.64), P < 0.001, ARR = 3%] and major 
      bleeding [RR (95% CI) = 0.68 (0.49-0.94), P = 0.02, ARR = 2.0%] as compared with 
      UFH. Conversely, no clear evidence of benefits with LWMHs was observed in the PCI 
      group after thrombolysis. Meta-regression showed that patients with a higher 
      baseline risk had greater benefits from LMWHs (r = 0.72, P = 0.02). CONCLUSIONS: 
      LMWHs were associated with greater efficacy and safety than UFH in STEMI patients 
      treated with pPCI, with a significant relationship between risk profile and 
      clinical benefits. Based on this meta-analysis, LMWHs may be considered as a 
      preferred anticoagulant among STEMI patients undergoing pPCI.
CI  - (c) 2011 International Society on Thrombosis and Haemostasis.
FAU - Navarese, E P
AU  - Navarese EP
AD  - Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium 
      Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. 
      eliano.navarese@alice.it
FAU - De Luca, G
AU  - De Luca G
FAU - Castriota, F
AU  - Castriota F
FAU - Kozinski, M
AU  - Kozinski M
FAU - Gurbel, P A
AU  - Gurbel PA
FAU - Gibson, C M
AU  - Gibson CM
FAU - Andreotti, F
AU  - Andreotti F
FAU - Buffon, A
AU  - Buffon A
FAU - Siller-Matula, J M
AU  - Siller-Matula JM
FAU - Sukiennik, A
AU  - Sukiennik A
FAU - De Servi, S
AU  - De Servi S
FAU - Kubica, J
AU  - Kubica J
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - *Angioplasty, Balloon, Coronary
MH  - Electrocardiography
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/drug therapy/mortality/physiopathology/*surgery
EDAT- 2011/07/23 06:00
MHDA- 2012/02/11 06:00
CRDT- 2011/07/23 06:00
PHST- 2011/07/23 06:00 [entrez]
PHST- 2011/07/23 06:00 [pubmed]
PHST- 2012/02/11 06:00 [medline]
AID - S1538-7836(22)07366-4 [pii]
AID - 10.1111/j.1538-7836.2011.04445.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2011 Oct;9(10):1902-15. doi: 10.1111/j.1538-7836.2011.04445.x.