Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: an ExTRACT-TIMI 25 analysis

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dc.contributor.authorGiraldez, Roberto R.
dc.contributor.authorNicolau, Jose Carlos
dc.contributor.authorCorbalan, Ramon
dc.contributor.authorGurfinkel, Enrique P.
dc.contributor.authorJuarez, Ursulo
dc.contributor.authorLopez Sendon, Jose
dc.contributor.authorParkhomenko, Alexander
dc.contributor.authorMolhoek, Peter
dc.contributor.authorMohanavelu, Satishkumar
dc.contributor.authorMorrow, David A.
dc.contributor.authorAntman, Elliott M.
dc.date.accessioned2024-01-10T12:05:14Z
dc.date.available2024-01-10T12:05:14Z
dc.date.issued2007
dc.description.abstractAims We compared outcomes of ST-elevation myocardial infarction (STEMI) patients randomized to a strategy of either enoxaparin or unfractionated heparin (UFH) to support fibrinolysis. Methods and results In the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis in Myocardial Infarction Study 25 (ExTRACT-TIMI 25) trial, 20 479 patients undergoing fibrinolysis for STEMI with a fibrin-specific agent (N = 16 283) or streptokinase (SK) IN = 4139) were randomized to enoxaparin throughout their hospitalization or UFH for at [east 48 h. The primary end point of death or nonfatal recurrent MI through 30 days occurred in 12.0% of patients in the UFH and 9.8% in the enoxaparin groups when treated with fibrin-specific lytics [odds ratio(adjusted) (ORadj) 0.78; 95% Cl 0.70-0.87; P < 0.001] and 11.8 vs. 10.2%, respectively, when treated with SK (ORadj 0.83; 95% CI 0.66-1.04; P = 0-10; P-interaction = 0.58). Major bleeding rates including intracranial hemorrhage within the fibrin specific cohort were 1.2 and 2.0% in the UFH and enoxaparin groups, respectively (P < 0.001) and 2.0% in UFH and 2.4% in enoxaparin patients in the SK cohort (P = 0.16). Interaction tests between antithrombin- and lytic-type were non-significant (P = 0.20). Death, nonfatal MI, or major bleeding was significantly reduced with enoxaparin in the fibrin-specific cohort (ORadj 0.82; 95% Cl 0.74-0.91; P < 0.001) and favoured enoxaparin in the SK cohort (ORadj 0.89; 95% Cl 0.72-1.10; P = 0.29; P-interaction = 0.53). Conclusion The benefits of an enoxaparin strategy over UFH were observed in both SK and fibrin -specific-treated STEMI patients. Therefore, an enoxaparin strategy is preferred over UFH to support fibrinolysis for STEMI regardless of lytic agent.
dc.fechaingreso.objetodigital2024-04-30
dc.format.extent8 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1093/eurheartj/ehm179
dc.identifier.eissn1522-9645
dc.identifier.issn0195-668X
dc.identifier.pubmedidMEDLINE:17562672
dc.identifier.urihttps://doi.org/10.1093/eurheartj/ehm179
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/75972
dc.identifier.wosidWOS:000248271600009
dc.information.autorucMedicina;Corbalán R;S/I;98700
dc.issue.numero13
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final1573
dc.pagina.inicio1566
dc.publisherOXFORD UNIV PRESS
dc.revistaEUROPEAN HEART JOURNAL
dc.rightsacceso restringido
dc.subjectSTEMI
dc.subjectenoxaparin
dc.subjectfibrin-specific lytics
dc.subjectstreptokinase
dc.subjectTISSUE PLASMINOGEN-ACTIVATOR
dc.subjectANTITHROMBIN THERAPY
dc.subjectTHROMBOLYSIS
dc.subjectREPERFUSION
dc.subjectASPIRIN
dc.subjectMORTALITY
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleEnoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: an ExTRACT-TIMI 25 analysis
dc.typeartículo
dc.volumen28
sipa.codpersvinculados98700
sipa.indexWOS
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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