Document Detail


Efficacy and safety of unfractionated heparin versus enoxaparin: a pooled analysis of ASSENT-3 and -3 PLUS data.
MedLine Citation:
PMID:  16682709     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal antithrombotic therapy to accompany tenecteplase in cases of acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We undertook a prespecified pooled analysis of data from the ASSENT-3 and ASSENT-3 PLUS trials. METHODS: We created a combined database of the 2040 and 818 patients who received enoxaparin in ASSENT-3 and ASSENT-3 PLUS, respectively, and compared them with the 2038 and 821 patients who received unfractionated heparin. RESULTS: The efficacy end point (a composite of 30-day mortality, reinfarction or refractory ischemia) was 12.2% with enoxaparin versus 16.0% with unfractionated heparin (p < 0.001); the combined end point of efficacy plus safety (a composite of 30-day mortality, reinfarction, refractory ischemia, intracranial hemorrhage [ICH] or major systemic bleeding) was 15.0% versus 18.0%, respectively (p = 0.003) [corrected] The 1049 patients urgently revascularized had greater benefit from enoxaparin (15.4% v. 10.1%, p = 0.013), yet the excess in major systemic bleeding evident with enoxaparin (3.3% v. 2.4%, p = 0.01) was largely confined to the 3492 patients without or before revascularization. Although ICH rates in the groups were similar (1.3% v. 0.9%, p = 0.26), an excess of ICH occurred among those administered enoxaparin during the ASSENT-3 PLUS trial (6.7% v. 0.8%, p = 0.013), especially among women over 75 years of age. INTERPRETATION: These data demonstrated the benefit of enoxaparin used in conjunction with tenecteplase, but raised caution about its prehospital use to treat STEMI in elderly women.
Authors:
Paul W Armstrong; Wei-Ching Chang; Lars Wallentin; Patrick Goldstein; Christopher B Granger; Kris Bogaerts; Thierry Danays; Frans Van de Werf;
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  174     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-09     Completed Date:  2006-06-06     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1421-6     Citation Subset:  AIM; IM    
Affiliation:
University of Alberta, Edmonton, Alta. paul.armstrong@ualberta.ca
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MeSH Terms
Descriptor/Qualifier:
Area Under Curve
Drug Therapy, Combination
Emergency Treatment
Enoxaparin / therapeutic use*
Fibrinolytic Agents / therapeutic use*
Heparin / therapeutic use*
Humans
Intracranial Hemorrhages / epidemiology
Logistic Models
Myocardial Infarction / drug therapy*
Randomized Controlled Trials as Topic
Recurrence
Thrombolytic Therapy*
Tissue Plasminogen Activator / therapeutic use
Chemical
Reg. No./Substance:
0/Enoxaparin; 0/Fibrinolytic Agents; 0/tenecteplase; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
CMAJ. 2006 May 9;174(10):1431-2   [PMID:  16682711 ]
Erratum In:
CMAJ. 2006 Jun 20;174(13):1874

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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