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

Eikelboom, John W.; Quinlan, Daniel J.; Mehta, Shamir R.; Turpie, Alexander G. G.; Menown, Ian; Yusuf, Salim

doi:10.1161/circulationaha.105.573550

Cited by 126 publications

(60 citation statements)

References 68 publications

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“…Nine randomized clinical trials 320,[331][332][333][334][335][336][337][338] and additional studies (including one meta-analyses) 339 document similar or improved composite outcomes (death, MI, and/or recurrent angina or recurrent ischemia or revascularization) when enoxaparin was administered instead of UFH to patients with STEMI undergoing fibrinolysis. This must be balanced against an increase in intracranial hemorrhage in patients Ͼ75 years of age who received enoxaparin documented in one of these randomized controlled trials.…”

Section: Unfractionated Heparin Versus Low-molecular-weight Heparin Wmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

237

167

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Section: Unfractionated Heparin Versus Low-molecular-weight Heparin Wmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

237

167

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“…For example, a meta-analysis of 14 trials that involved Ͼ25 000 patients with STEMI examined the use of unfractionated heparin and LMWH when added to aspirin and fibrinolytic therapy. 103 Intravenous unfractionated heparin during hospitalization did not prevent reinfarction or death; however, LMWH given for 4 to 8 days reduced reinfarction by Ϸ25% and death by Ϸ10% compared with placebo and reduced reinfarction by almost one half when directly compared with unfractionated heparin. 103 The potential benefit of combination therapy with platelet GP IIb/IIIa inhibitors and fibrinolytics has been evaluated in STEMI patients both in angiographic trials [81][82][83][84] and in trials with "hard" clinical events as the primary outcome.…”

Section: Pharmacological Therapymentioning

confidence: 89%

“…103 Intravenous unfractionated heparin during hospitalization did not prevent reinfarction or death; however, LMWH given for 4 to 8 days reduced reinfarction by Ϸ25% and death by Ϸ10% compared with placebo and reduced reinfarction by almost one half when directly compared with unfractionated heparin. 103 The potential benefit of combination therapy with platelet GP IIb/IIIa inhibitors and fibrinolytics has been evaluated in STEMI patients both in angiographic trials [81][82][83][84] and in trials with "hard" clinical events as the primary outcome. 86 Although mortality trials using a reduced dose of reteplase (GUSTO-V) 86 or tenecteplase (Assessment of the Safety and Efficacy of a New Thrombolytic Regimen [ASSENT-3]) 74 showed that combined use of a GP IIb/IIIa inhibitor with a reduced-dose fibrinolytic enhanced coronary artery patency versus full-dose fibrinolytic therapy alone, combination therapy with these agents plus abciximab failed to show any early or late survival benefit over full-dose fibrinolytics alone or any reduction in the risk of intracranial hemorrhage.…”

Section: Pharmacological Therapymentioning

confidence: 89%

The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes

et al. 2006

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“…For patients with STEMI to be treated with fibrinolysis, 17 studies supported enoxaparin over UFH (LOE1 336,[387][388][389][390][391][392][393] ; LOE 2 341,394,395,396 ; LOE 4 397 ; LOE 5 393,396,398 -401 ) Twelve other studies were neutral comparing enoxaparin and UFH. [402][403][404][405][406][407][408][409][410][411] Reviparin.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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

Cited by 126 publications

References 68 publications

Part 10: Acute Coronary Syndromes

Part 10: Acute Coronary Syndromes

The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes

Part 9: Acute Coronary Syndromes

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