PMID- 21796875
OWN - NLM
STAT- MEDLINE
DCOM- 20110811
LR  - 20110729
IS  - 1128-3602 (Print)
IS  - 1128-3602 (Linking)
VI  - 15
IP  - 6
DP  - 2011 Jun
TI  - A critical review of the efficacy and safety in the use of low-molecular-weight 
      heparin in acute ST-elevation myocardial infarction: a Bayesan approach.
PG  - 701-10
AB  - BACKGROUND: ST segment elevation myocardial infarction (STEMI) is an important 
      risk factor of death worldwide. Significant clinical research has been done to 
      assess ideal reperfusion strategies in the setting of STEMI, including the role 
      of the antithrombin agents: unfractionated heparin (UFH) and low molecular weight 
      heparin (LMWH). Given the evidence that LMWH may be safer than UFH in the 
      treatment of other thrombotic disorders, its role in the management of STEMI 
      needs to be more defined. OBJECTIVE: To assess the safety and efficacy of LMWH 
      compared to UFH and/or placebo for the treatment of STEMI. MATERIALS AND METHODS: 
      The Cochrane Library, MedLine and EMABASE databases were searched for randomized 
      controlled trials pertinent to the study objective. Selection criteria included 
      all randomized controlled trials comparing LMWH to either UFH or placebo in the 
      treatment of STEMI through December 2010. Two Authors performed the search 
      independently.After identifying appropriate studies, a random effect model and 
      Bayesian sensitivity analysis were used to combine results from original trials 
      and assess the consistency of results. RESULTS: We identified 13 studies that met 
      the described selection criteria; 8 comparing LMWH to UFH and 5 to placebo in 
      STEMI patients. The combined Odd's ratio was 0.79 with a 95% confidence interval 
      of 0.67-0.94 for all studies and 0.74 (0.54-1.02) for those comparing LMWH to UFH 
      only. A trend toward more frequent hemorrhagic events was identified in the LMWH 
      group (Odd's ratio 1.40) which did not meet statistical significance (95% 
      confidence interval 0.80-2.47). Sensitivity analysis demonstrated clinical 
      benefits of 6% and 12.5% with probabilities of 99% and 95% respectively. 
      CONCLUSION: Compared to placebo or UFH, LMWH is effective as a first line 
      treatment of STEMI patient with no significant increase in major hemorrhagic 
      events.
FAU - Buccelletti, E
AU  - Buccelletti E
AD  - Department of Emergency Medicine, School of Medicine, Catholic University of the 
      Sacred Heart, Rome, Italy. Francesco.buccelletti@mssm.edu
FAU - Spadaccio, C
AU  - Spadaccio C
FAU - Chello, M
AU  - Chello M
FAU - Marsiliani, D
AU  - Marsiliani D
FAU - Carroccia, A
AU  - Carroccia A
FAU - Iacomini, P
AU  - Iacomini P
FAU - Calabro, G
AU  - Calabro G
FAU - Gentiloni Silveri, N
AU  - Gentiloni Silveri N
FAU - Franceschi, F
AU  - Franceschi F
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - Eur Rev Med Pharmacol Sci
JT  - European review for medical and pharmacological sciences
JID - 9717360
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Bayes Theorem
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Models, Statistical
MH  - Myocardial Infarction/*drug therapy/physiopathology
MH  - Randomized Controlled Trials as Topic
EDAT- 2011/07/30 06:00
MHDA- 2011/08/13 06:00
CRDT- 2011/07/30 06:00
PHST- 2011/07/30 06:00 [entrez]
PHST- 2011/07/30 06:00 [pubmed]
PHST- 2011/08/13 06:00 [medline]
PST - ppublish
SO  - Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):701-10.