Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents.
نویسندگان
چکیده
BACKGROUND Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. METHODS A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. RESULTS The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex. CONCLUSIONS The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.
منابع مشابه
Incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction: the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial.
BACKGROUND Reinfarction after primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction has negative consequences. Little is known about reinfarction after drug-eluting stents and bivalirudin anticoagulation. We, therefore, sought to determine the incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention...
متن کامل[Antithrombotic therapy in acute coronary syndrome].
ABBREVIATIONS IN THIS CHAPTER ACS Acute coronary syndrome BMS Bare metal stent CABG Coronary artery bypass grafting DAPT Dual antiplatelet therapy DES Drug-eluting stent GPI Glycoprotein IIb/IIIa inhibitor HIT Heparin-induced thrombocytopenia NSTE ACS Non–ST-segment elevation acute coronary syndrome PCI Percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction UA Unsta...
متن کاملActivated clotting time and outcomes during percutaneous coronary intervention for non-ST-segment-elevation myocardial infarction: insights from the FUTURA/OASIS-8 Trial.
BACKGROUND Activated clotting time (ACT) is widely used to guide unfractionated heparin dosing during percutaneous coronary intervention. However, its value in predicting complications is controversial in the modern era. We sought to examine the relationship between ACT and outcomes in non-ST-segment-elevation acute coronary syndrome patients. METHODS AND RESULTS In the Fondaparinux With Unfr...
متن کاملMethods and Results—In the Fondaparinux With Unfractionated Heparin During Revascularization in Acute Coronary Syndromes
Periprocedural anticoagulation is recommended during percutaneous coronary intervention (PCI) to prevent thrombus forming on the wires, balloon, and catheters. Unfractionated heparin (UFH) remains widely used in this indication (≈60% of patients with non–ST-segment–elevation myocardial infarction [NSTEMI] undergoing PCI in the United States received UFH, according to data from the recent Nation...
متن کاملAnticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomized trials in the era of stents and P2Y12 inhibitors
OBJECTIVES To investigate the relative benefits of unfractionated heparin, low molecular weight heparin(LMWH), fondaparinux, and bivalirudin as treatment options for patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). DESIGN Mixed treatment comparison and direct comparison meta-analysis of randomized trials in the era of stents and P2Y...
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عنوان ژورنال:
- American heart journal
دوره 160 2 شماره
صفحات -
تاریخ انتشار 2010