A randomized trial of intravenous heparin in conjunction with anistreplase (anisoylated plasminogen streptokinase activator complex) in acute myocardial infarction: The Duke University clinical cardiology study (DUCCS) 1

Abstract

Weight-adjusted intravenous heparin therapy after APSAC in acute myocardial infarction does not reduce the combined incidence of death, reinfarction, recurrent ischemia and occlusion of the infarct-related artery. Furthermore, withholding intravenous heparin therapy is associated with a 46% reduction in bleeding complications. Our findings do not support the addition of intravenous heparin after APSAC therapy, as currently recommended, and suggest that a strategy of withholding heparin is simpler and safer and does not place the patient at increased risk for ischemic complications after myocardial infarction.

Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction

“…Concealment of treatment allocation appeared adequate in the 3 studies that reported this. 42,43,45 Two of the 4 studies were double-blind and placebo controlled, 43,44 and follow-up was complete in the 1 study that reported this. 42 …”

“…39,40 Clinical outcome data could not be obtained for 1 additional study, 41 leaving 14 randomized trials, involving a combined total of 25 280 patients, for inclusion in the meta-analysis (Tables 1 to 3). 11,[42][43][44][45][46][47][48][49][50][51][52][53][54] Table 1 summarizes the study designs. [42][43][44][45] Two studies used streptokinase, 42,44 1 alteplase, 43 and 1 anistreplase.…”

“…11,[42][43][44][45][46][47][48][49][50][51][52][53][54] Table 1 summarizes the study designs. [42][43][44][45] Two studies used streptokinase, 42,44 1 alteplase, 43 and 1 anistreplase. 44 The initial dose of aspirin was at least 200 mg in all the trials and was followed by a maintenance dose of between 75 and 325 mg/d.…”

Guide to Anticoagulant Therapy: Heparin

“…There was a small difference in coronary artery patency (80% in the heparin group versus 74% in the control group). 148 Two large trials, the International Study Group 149 and the ISIS-3 150 (International Study of Infarct Survival) studies, assessed the value of adjunctive heparin in patients receiving thrombolytic therapy and aspirin. In both, heparin was given (12 500 U SC every 12 hours).…”

Low-Molecular-Weight Heparins in Conjunction with Thrombolysis for ST-Elevation Acute Myocardial Infarction

“…The intravenous administration of unfractionated heparin (UFH) is the only anti-coagulant treatment currently recommended as an adjunct to fibrin-specific thrombolytics for the treatment of ST-elevation acute myocardial infarction (STEMI) [1, 2], in order to improve early recanalization and reduce reocclusion and reinfarction rates [3,4,5,6,7,8,9,10,11,12]. UFH, however, has several pharmacokinetic (i.e.…”