Efficacy and Safety of Enoxaparin Versus Unfractionated Heparin in Patients With ST-Segment Elevation Myocardial Infarction Also Treated With Clopidogrel

Abstract

In patients with STEMI receiving fibrinolytic therapy, the net benefit of ENOX is similar in patients who are and are not treated with clopidogrel. The totality of trial data suggest that the combination of a fibrinolytic, aspirin, clopidogrel, and ENOX offers an attractive pharmacologic reperfusion strategy in STEMI.

Efficacy and Safety of Immediate Angioplasty Versus Ischemia-Guided Management After Thrombolysis in Acute Myocardial Infarction in Areas With Very Long Transfer Distances

“…The rate of GUSTO severe bleeding was as reported in other trials (1.9%); however, the rate of intracranial hemorrhage was higher than expected (19). The heavy loading of patients with antithrombotic drugs might be of concern, but recent analysis has not shown any increase in intracranial hemorrhages when adding enoxaparin and clopidogrel to fibrinolytic treatment (20).…”

Cost Effectiveness of Enoxaparin in Acute ST-Segment Elevation Myocardial Infarction

“…The clinical benefits of using enoxaparin instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI appears to be independent of the lytic choice and has been observed with fibrin-specific lytics as well as with streptokinase (31). Concomitant treatment with clopidogrel does not reduce these benefits (32). The net clinical benefit of this strategy has also been shown in patients with renal dysfunction (33).…”

Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in patients with non-ST segment elevation acute coronary syndromes in clinical practice

“…The efficacy of enoxaparin and clopidogrel has been shown before, but it has been unclear if the combination of enoxaparin and clopidogrel in a real world scenario has additive beneficial or rather deleterious effects with an excess in bleeding complications and mortality. A recent subanalysis of the ExTRACT-TIMI 25 (enoxaparin and thrombolysis reperfusion for acute myocardial infarction treatment-thrombolysis In myocardial infarction 25) trial found that in ST elevation myocardial infarction the combination of a fibrinolytic, aspirin, clopidogrel and enoxaparin was associated with a reduction of MACE [24]. These results cannot easily be transferred to patients with NSTE-ACS, as there is no therapy with a fibrinolytic and STEMI patients usually are younger with less comorbidities.…”