| Adjunctive low molecular weight heparin during fibrinolytic therapy in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized control trials. | |
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MedLine Citation:
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PMID: 19609890 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Sarabjeet Singh; Amol Bahekar; Janos Molnar; Sandeep Khosla; Rohit Arora |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: Clinical cardiology Volume: 32 ISSN: 1932-8737 ISO Abbreviation: Clin Cardiol Publication Date: 2009 Jul |
Date Detail:
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Created Date: 2009-08-03 Completed Date: 2010-02-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7903272 Medline TA: Clin Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 358-64 Citation Subset: IM |
Affiliation:
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Department of Medicine, Chicago Medical School, North Chicago, Illinois 60064, USA. sarabjeetsingh_2000@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anticoagulants
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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* Hospitalization Humans Length of Stay Myocardial Infarction / drug therapy*, mortality Platelet Aggregation Inhibitors / therapeutic use Randomized Controlled Trials as Topic Recurrence Risk Assessment Thrombolytic Therapy* / adverse effects, mortality Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Platelet Aggregation Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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