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Utilizing enoxaparin in the management of STEMI.

Rubboli A, Capecchi A, Di Pasquale G - Vasc Health Risk Manag (2007)

Bottom Line: In 8 published open-label studies including about 10,000 patients, in which enoxaparin was compared to either placebo or unfractionated heparin (UFH), a general superiority of enoxaparin on both reinfarction/recurrent angina and patency of the infarct-related artery, was observed.Overall, bleeding rate with enoxaparin was higher than with placebo and comparable to UFH, with the exception of one study where pre-hospital administration induced a doubled incidence of intracranial bleeding in patients older than 75 years.Along with its easiness of use, not requiring laboratory monitoring, the subcutaneous administration of enoxaparin allows extended antithrombotic treatment, while permitting early mobilization (and rehabilitation) of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Maggiore Hospital, Bologna, Italy. andrearubboli@libero.it

ABSTRACT
The use of enoxaparin in conjunction with thrombolysis in ST-elevation acute myocardial infarction (STEMI), has been recently investigated in several clinical trials. In 8 published open-label studies including about 10,000 patients, in which enoxaparin was compared to either placebo or unfractionated heparin (UFH), a general superiority of enoxaparin on both reinfarction/recurrent angina and patency of the infarct-related artery, was observed. Overall, bleeding rate with enoxaparin was higher than with placebo and comparable to UFH, with the exception of one study where pre-hospital administration induced a doubled incidence of intracranial bleeding in patients older than 75 years. 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 definitively proven. In conclusion, initial intravenous bolus of enoxaparin followed by twice daily subcutaneous administration for about 1 week should be considered instead of intravenous UFH for the treatment of patients with STEMI receiving thrombolysis. Along with its easiness of use, not requiring laboratory monitoring, the subcutaneous administration of enoxaparin allows extended antithrombotic treatment, while permitting early mobilization (and rehabilitation) of patients.

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Related in: MedlinePlus

Efficacy and safety outcomes at 30 days in the ExTRACT-TIMI 25 study.Abbreviations: UFH, unfractionated heparin; ICH, intracranial hemorrhage; RR, relative risk; NS, nonsignificant.
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fig2: Efficacy and safety outcomes at 30 days in the ExTRACT-TIMI 25 study.Abbreviations: UFH, unfractionated heparin; ICH, intracranial hemorrhage; RR, relative risk; NS, nonsignificant.

Mentions: In this multi-center, double-blind, randomized trial, over 20,000 patients receiving either a fibrin- or non fibrin-specific thrombolytic and aspirin, were randomized to enoxaparin 30 mg as an intravenous bolus followed by 1 mg/kg twice daily subcutaneously for up to 8 days, or intravenous bolus of UFH 60 IU/kg followed by infusion of 12 IU/kg/h for 48 hours (Antman et al 2006). The primary end-point was the composite of death or reinfarction at 30 days, whereas secondary end points were the composite of death and reinfarction/recurrent ischemia and the composite of death, recurrent reinfarction and disabling stroke at 30 days. Enoxaparin was significantly more effective than UFH on both in-hospital (7% vs 9%; p < 0.001) and 30-day (10% vs 12%; p < 0.001) primary end points (Figures 1 and 2). In both cases, this result was mainly driven by the significant decrease in reinfarction, since mortality was not substantially affected (Figures 1 and 2). Major bleedings were significantly more frequent with enoxaparin at both 8 and 30 days, although the occurrence of intracranial hemorrhage was comparable (Figures 1 and 2). However, the net clinical benefit at 30 days, defined as the combined occurrence of death, reinfarction and either nonfatal disabling stroke, major bleeding or intracranial hemorrhage, was significantly higher with enoxaparin, which was associated with a significant 14 to 18% relative risk reduction of these events compared to UFH (Antman et al 2006).


Utilizing enoxaparin in the management of STEMI.

Rubboli A, Capecchi A, Di Pasquale G - Vasc Health Risk Manag (2007)

Efficacy and safety outcomes at 30 days in the ExTRACT-TIMI 25 study.Abbreviations: UFH, unfractionated heparin; ICH, intracranial hemorrhage; RR, relative risk; NS, nonsignificant.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2291313&req=5

fig2: Efficacy and safety outcomes at 30 days in the ExTRACT-TIMI 25 study.Abbreviations: UFH, unfractionated heparin; ICH, intracranial hemorrhage; RR, relative risk; NS, nonsignificant.
Mentions: In this multi-center, double-blind, randomized trial, over 20,000 patients receiving either a fibrin- or non fibrin-specific thrombolytic and aspirin, were randomized to enoxaparin 30 mg as an intravenous bolus followed by 1 mg/kg twice daily subcutaneously for up to 8 days, or intravenous bolus of UFH 60 IU/kg followed by infusion of 12 IU/kg/h for 48 hours (Antman et al 2006). The primary end-point was the composite of death or reinfarction at 30 days, whereas secondary end points were the composite of death and reinfarction/recurrent ischemia and the composite of death, recurrent reinfarction and disabling stroke at 30 days. Enoxaparin was significantly more effective than UFH on both in-hospital (7% vs 9%; p < 0.001) and 30-day (10% vs 12%; p < 0.001) primary end points (Figures 1 and 2). In both cases, this result was mainly driven by the significant decrease in reinfarction, since mortality was not substantially affected (Figures 1 and 2). Major bleedings were significantly more frequent with enoxaparin at both 8 and 30 days, although the occurrence of intracranial hemorrhage was comparable (Figures 1 and 2). However, the net clinical benefit at 30 days, defined as the combined occurrence of death, reinfarction and either nonfatal disabling stroke, major bleeding or intracranial hemorrhage, was significantly higher with enoxaparin, which was associated with a significant 14 to 18% relative risk reduction of these events compared to UFH (Antman et al 2006).

Bottom Line: In 8 published open-label studies including about 10,000 patients, in which enoxaparin was compared to either placebo or unfractionated heparin (UFH), a general superiority of enoxaparin on both reinfarction/recurrent angina and patency of the infarct-related artery, was observed.Overall, bleeding rate with enoxaparin was higher than with placebo and comparable to UFH, with the exception of one study where pre-hospital administration induced a doubled incidence of intracranial bleeding in patients older than 75 years.Along with its easiness of use, not requiring laboratory monitoring, the subcutaneous administration of enoxaparin allows extended antithrombotic treatment, while permitting early mobilization (and rehabilitation) of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Maggiore Hospital, Bologna, Italy. andrearubboli@libero.it

ABSTRACT
The use of enoxaparin in conjunction with thrombolysis in ST-elevation acute myocardial infarction (STEMI), has been recently investigated in several clinical trials. In 8 published open-label studies including about 10,000 patients, in which enoxaparin was compared to either placebo or unfractionated heparin (UFH), a general superiority of enoxaparin on both reinfarction/recurrent angina and patency of the infarct-related artery, was observed. Overall, bleeding rate with enoxaparin was higher than with placebo and comparable to UFH, with the exception of one study where pre-hospital administration induced a doubled incidence of intracranial bleeding in patients older than 75 years. 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 definitively proven. In conclusion, initial intravenous bolus of enoxaparin followed by twice daily subcutaneous administration for about 1 week should be considered instead of intravenous UFH for the treatment of patients with STEMI receiving thrombolysis. Along with its easiness of use, not requiring laboratory monitoring, the subcutaneous administration of enoxaparin allows extended antithrombotic treatment, while permitting early mobilization (and rehabilitation) of patients.

Show MeSH
Related in: MedlinePlus