Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction: the AMI-SK study

Ml, Simoons; Krzemińska‐Pakuła, Maria; Alonso, Adrián

doi:10.1016/s1062-1458(02)00992-3

Cited by 18 publications

(29 citation statements)

References 22 publications

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“…Enoxaparin improved the primary endpoint of TIMI grade 3 flow (70 versus 58% with placebo; p=0.01) and reduced the triple clinical endpoint of death, reinfarction, and recurrent angina at day 30 from 21% in the placebo group to 13% in the enoxaparin group (p=0.03). There were no significant differences in the rate of protocol-defined major bleeding (4.8 versus 2.5%; p=0.2) or TIMI major bleeding (1.6 versus 0.8%) [8]. In a study of 300 STEMI patients, adjunctive enoxaparin (initial 40 mg IV bolus followed by 40 mg SC every 8 h for 4 days) to streptokinase or anistreplase was superior to UFH (initial 5,000 IU IV bolus followed by 30,000 IU/day adjusted-dose UFH) with a 26% incidence of the 90 day triple endpoint of death, non-fatal reinfarction, or unstable angina with enoxaparin versus 36% with UFH; p=0.04).…”

Section: Enoxaparinmentioning

confidence: 79%

“…Multiple studies have evaluated enoxaparin used as adjunct to a number of standard thrombolytic therapies including streptokinase, alteplase, and tenecteplase in patients with STEMI [8][9][10][11][12][13]26]. In the Acute Myocardial Infarction Streptokinase (AMI-SK) study, the efficacy of SC enoxaparin (1 mg/kg twice daily) was compared to placebo over 3-8 days in 496 STEMI patients treated with IV streptokinase.…”

Section: Enoxaparinmentioning

confidence: 99%

“…However, other studies on the use of enoxaparin in STEMI patients have used an initial IV bolus of enoxaparin followed by SC dosing, rather than SC administration only [5, 7-9, 35, 37]. These studies have not reported any issues with catheter thrombosis in STEMI patients treated with enoxaparin in expedited primary PCI [35,37] or in PCI following thrombolytic treatment [5,[7][8][9]. Indeed, when SC enoxaparin was combined with supplemental IV enoxaparin in the WEST study, an adequate antithrombotic effect was achieved in all patients [39].…”

Section: Stemi Patients Undergoing Pcimentioning

confidence: 99%

“…In addition, potentially relevant articles were identified from within the reference lists of key articles already identified as of relevance. Clinical trials identified for inclusion in this review numbered four for dalteparin, one for reviparin, nine for enoxaparin, two for fondaparinux, one for desirudin, and three for bivalirudin (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. No trials were identified for ardeparin and tinzaparin in STEMI patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin

Gurm

Eagle

2007

Cardiovasc Drugs Ther

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Section: Enoxaparinmentioning

confidence: 79%

Section: Enoxaparinmentioning

confidence: 99%

Section: Stemi Patients Undergoing Pcimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin

Gurm

Eagle

2007

Cardiovasc Drugs Ther

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“…Whether LMWH can replace UFH combined with lytic agents has mostly been addressed within angiographic studies (Table 2) [12][13][14][15][16][17].…”

Section: Low Molecular Weight Heparin: Evidence In Stemimentioning

confidence: 99%

Is the use of unfractionated heparin in acute coronary syndrome outmoded?

Chiquette

Chilton

2004

Curr Atheroscler Rep

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Because of the key role of thrombin in the pathogenesis of acute coronary syndrome (ACS), the appropriate selection of antithrombotic therapy is important. Unfractionated heparin (UFH) has been the agent of choice for decades. Unfortunately, UFH has a number of limitations related to its pharmacokinetic and pharmacodynamic properties. Low molecular weight heparins (LMWHs) are attractive alternatives to UFH for several reasons, including predictable anticoagulation and ease of administration. Two LMWHs (dalteparin and enoxaparin) have been approved as alternatives to UFH in patients presenting with unstable angina and non-ST-segment elevation myocardial infarction. Randomized, controlled trials, in addition to open-label series, indicate that LMWH can safely be the agent of choice with or without glycoprotein IIb/IIIa in the medical and upstream management of patients with ACS. Although the data are not definitive, several trials suggest that given intravenously, enoxaparin is safe as the sole antithrombotic agent in the catheterization laboratory.

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Low‐molecular‐weight heparin vs. unfractionated heparin in percutaneous coronary intervention: A combined analysis

Borentain¹,

Montalescot²,

Bouzamondo

et al. 2005

Cathet Cardio Intervent

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This meta-analysis assessed the rates of the efficacy and safety endpoints with intravenous low-molecular-weight heparin (LMWH) compared with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI). Subcutaneous LMWH has compared favorably with UFH, but limited experience exists with intravenous LMWH for immediate anticoagulation in PCI. The meta-analysis included data from eight randomized trials in which patients received LMWH (n = 1,037) or UFH (n = 978) during PCI. Seven additional nonrandomized studies/registries were analyzed to assess the efficacy and safety of LMWH during PCI. Efficacy endpoints were ischemic events (usually a composite of death, myocardial infarction, and urgent revascularization) and the safety endpoint was bleeding (major, minor, or all bleeding). In the randomized studies, LMWH was comparable with UFH in terms of efficacy (6.2% vs. 7.5%) and major bleeding (0.9% vs. 1.8%). The analysis of pooled data, randomized or not, suggests potential improved efficacy (5.8% vs. 7.6%) and reduced major bleeding (0.6% vs. 1.8%) with LMWH (n = 3,787) compared with UFH (n = 978). During PCI, intravenous LMWH without coagulation monitoring has the potential to be at least as safe and efficacious as intravenous UFH. Further studies of LMWHs in PCI are therefore required.

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Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction: the AMI-SK study

Cited by 18 publications

References 22 publications

Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin

Use of Anticoagulants in ST-Segment Elevation Myocardial Infarction Patients; A Focus on Low-Molecular-Weight Heparin

Is the use of unfractionated heparin in acute coronary syndrome outmoded?

Low‐molecular‐weight heparin vs. unfractionated heparin in percutaneous coronary intervention: A combined analysis

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