Document Detail

Adjunctive low molecular weight heparin during fibrinolytic therapy in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized control trials.
MedLine Citation:
PMID:  19609890     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Recent data suggests that low molecular weight heparins (LMWHs) may be superior to unfractionated heparin (UFH) as an adjunct to fibrinolytic therapy in patients with acute ST-segment elevation myocardial infarction (STEMI). HYPOTHESIS: We evaluated cardiac outcomes and the risk of major bleeding with LMWHs vs UFH in the management of STEMI. METHODS: Seven randomized trials of patients with acute STEMI treated with fibrinolytic therapy and adjunctive LMWHs through the index hospitalization or weight-based UFH for at least 48 hours were identified. We analyzed both primary endpoints (death and nonfatal recurrent myocardial infarction through 30 days), and secondary endpoints (death, recurrent myocardial infarction, and major bleeding during index hospitalization at 7 days). Outcomes were computed using the Mantel-Haenszel fixed-effect model. A 2-sided alpha error of < 0.05 was considered significant. RESULTS: Compared to UFH, LMWH significantly reduced reinfarction (p < 0.001) during hospitalization at 7 days and the effect remained consistent at 30 d (p < 0.001). When analyzed for mortality at 7 days and 30 days follow-up, there were no statistically significant differences observed between the 2 groups. Additionally the LMWH group had higher risk of major bleeding (p < 0.001). CONCLUSIONS: The present meta-analysis suggests in patients receiving fibrinolytic therapy for STEMI, LMWHs as an adjunctive therapy is superior to UFH in reducing reinfarction during hospitalization at 7 days and at 30 days. The mortality was not significant between the 2 groups during hospitalization at 7 days and at 30 days. However, UFH is superior to LMWHs in the reduction of major bleeding at 7 days index hospitalization.
Sarabjeet Singh; Amol Bahekar; Janos Molnar; Sandeep Khosla; Rohit Arora
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Clinical cardiology     Volume:  32     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-08-03     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  358-64     Citation Subset:  IM    
Department of Medicine, Chicago Medical School, North Chicago, Illinois 60064, USA.
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MeSH Terms
Anticoagulants / adverse effects,  therapeutic use*
Drug Therapy, Combination
Evidence-Based Medicine
Fibrinolytic Agents / adverse effects,  therapeutic use*
Hemorrhage / chemically induced
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use*
Length of Stay
Myocardial Infarction / drug therapy*,  mortality
Platelet Aggregation Inhibitors / therapeutic use
Randomized Controlled Trials as Topic
Risk Assessment
Thrombolytic Therapy* / adverse effects,  mortality
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Platelet Aggregation Inhibitors

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