PMID- 25988359
OWN - NLM
STAT- MEDLINE
DCOM- 20160308
LR  - 20181202
IS  - 1879-1484 (Electronic)
IS  - 0021-9150 (Linking)
VI  - 241
IP  - 1
DP  - 2015 Jul
TI  - Unfractionated heparin-clopidogrel combination in ST-elevation myocardial 
      infarction not receiving reperfusion therapy.
PG  - 151-6
LID - S0021-9150(15)01012-6 [pii]
LID - 10.1016/j.atherosclerosis.2015.04.794 [doi]
AB  - OBJECTIVE: We sought explore the relative benefits of unfractionated heparin 
      (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in 
      ST-segment elevation myocardial infarction (STEMI) patients not undergoing 
      reperfusion therapy. METHODS: This is a propensity score study from The 
      International Survey on Acute Coronary Syndromes in Transition Countries 
      (ISACS-TC/NCT01218776) on patients admitted between October 2010-June 2013. There 
      were a total of 1175 STEMI patients who did not receive mechanical or 
      pharmacological reperfusion. Of these, 1063 were eligible for the aim of the 
      study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). 
      Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) 
      patients. The primary endpoint was in-hospital mortality. Secondary endpoints 
      were intracranial hemorrhages, and clinically relevant bleedings. RESULTS: After 
      adjustment for any confounders, UFH was associated with a lower risk of 
      in-hospital mortality in clopidogrel users (multivariate adjusted regression 
      analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41-0.94) as 
      compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55-1.60). The observed 
      effect was not associated with combined enoxaparin and clopidogrel therapy. Major 
      bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 
      1.5% respectively, p = 0.06). The risk of major hemorrhage was nearly similar 
      with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), 
      p = 0.67. CONCLUSION: UFH - Clopidogrel combination was associated with a large 
      mortality reduction in STEMI patients not undergoing reperfusion therapy and did 
      not significantly increase the risk of major bleeding.
CI  - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved.
FAU - Bugiardini, Raffaele
AU  - Bugiardini R
AD  - Department of Experimental, Diagnostic and Specialty Medicine, University of 
      Bologna, Italy. Electronic address: raffaele.bugiardini@unibo.it.
FAU - Dorobantu, Maria
AU  - Dorobantu M
AD  - Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, 
      Bucharest, Romania.
FAU - Vasiljevic, Zorana
AU  - Vasiljevic Z
AD  - Clinical Center of Serbia, University of Belgrade, Serbia.
FAU - Kedev, Sasko
AU  - Kedev S
AD  - University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, 
      Macedonia.
FAU - Knezevic, Bozidarka
AU  - Knezevic B
AD  - Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
FAU - Milicic, Davor
AU  - Milicic D
AD  - Department for Cardiovascular Diseases, University Hospital Center Zagreb, 
      University of Zagreb, Croatia.
FAU - Calmac, Lucian
AU  - Calmac L
AD  - Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, 
      Bucharest, Romania.
FAU - Trninic, Dijana
AU  - Trninic D
AD  - Clinical Center of Banja Luka, Republika Srpska, Bosnia and Herzegovina.
FAU - Daullxhiu, Irfan
AU  - Daullxhiu I
AD  - Department of Cardiology, University Clinical Centre of Kosovo, Prishtina, 
      Kosovo.
FAU - Cenko, Edina
AU  - Cenko E
AD  - Department of Experimental, Diagnostic and Specialty Medicine, University of 
      Bologna, Italy.
FAU - Ricci, Beatrice
AU  - Ricci B
AD  - Department of Experimental, Diagnostic and Specialty Medicine, University of 
      Bologna, Italy.
FAU - Puddu, Paolo Emilio
AU  - Puddu PE
AD  - Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and 
      Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
FAU - Manfrini, Olivia
AU  - Manfrini O
AD  - Department of Experimental, Diagnostic and Specialty Medicine, University of 
      Bologna, Italy.
FAU - Koller, Akos
AU  - Koller A
AD  - Institute of Natural Sciences, University of Physical Education, Budapest H-1123, 
      Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, 
      USA.
FAU - Badimon, Lina
AU  - Badimon L
AD  - Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, 
      CiberObn-Institute Carlos III, Autonomous University of Barcelona, Spain.
CN  - ISACS-TC Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT01218776
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20150427
PL  - Ireland
TA  - Atherosclerosis
JT  - Atherosclerosis
JID - 0242543
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Enoxaparin/adverse effects/*therapeutic use
MH  - Europe
MH  - Female
MH  - Fibrinolytic Agents/adverse effects/*therapeutic use
MH  - Health Care Surveys
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Intracranial Hemorrhages/chemically induced
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Infarction/diagnosis/*drug therapy/mortality
MH  - Odds Ratio
MH  - Platelet Aggregation Inhibitors/adverse effects/*therapeutic use
MH  - Propensity Score
MH  - Registries
MH  - Risk Factors
MH  - Ticlopidine/adverse effects/*analogs & derivatives/therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Clopidogrel
OT  - Enoxaparin
OT  - No-reperfusion therapy
OT  - Outcomes
OT  - ST-segment elevation myocardial infarction
OT  - Unfractionated heparin
EDAT- 2015/05/20 06:00
MHDA- 2016/03/10 06:00
CRDT- 2015/05/20 06:00
PHST- 2014/12/08 00:00 [received]
PHST- 2015/04/20 00:00 [revised]
PHST- 2015/04/23 00:00 [accepted]
PHST- 2015/05/20 06:00 [entrez]
PHST- 2015/05/20 06:00 [pubmed]
PHST- 2016/03/10 06:00 [medline]
AID - S0021-9150(15)01012-6 [pii]
AID - 10.1016/j.atherosclerosis.2015.04.794 [doi]
PST - ppublish
SO  - Atherosclerosis. 2015 Jul;241(1):151-6. doi: 
      10.1016/j.atherosclerosis.2015.04.794. Epub 2015 Apr 27.