| Low-Molecular-Weight Heparins vs Unfractionated Heparin in the Setting of Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction: a Meta-analysis. | |
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MedLine Citation:
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PMID: 21777368 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background: The aim of the current study was to perform two separate meta-analyses of available studies comparing low-molecular-weight heparins (LMWHs) versus unfractionated heparin (UFH) in ST-elevation myocardial infarction (STEMI) patients treated 1) with primary percutaneous coronary intervention (pPCI) or 2) with PCI after thrombolysis. Methods: All-cause mortality was the prespecified primary endpoint and major bleeding complications were recorded as secondary endpoint. Relative risk (RR) with 95% confidence interval (CI) and absolute risk reduction (ARR) were chosen as the effect measure. Results: Ten studies comprising 16286 patients were included. The median follow-up was two months for the primary endpoint. Among LMWHs, enoxaparin was the compound most frequently used. In the pPCI group LMWHs were associated with a reduction in mortality (RR [95% CI] = 0.51 [0.41 - 0.64], p < 0.001, ARR = 3%) and major bleeding (RR [95% CI] = 0.68 [0.49 - 0.94], p = 0.02, ARR = 2.0%) as compared to UFH. Conversely, no clear evidence of benefits with LWMHs was observed in the PCI group after thrombolysis. Meta-regression showed that patients with higher baseline risk had larger benefits from LMWHs (r = 0.72, p = 0.02). Conclusions: LMWHs were associated with greater efficacy and safety than UFH in STEMI patients treated with pPCI, with a significant relationship between risk profile and clinical benefits. Based on this meta-analysis, LMWHs may be considered as a preferred anticoagulant among STEMI patients undergoing pPCI. |
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Authors:
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E P Navarese; G De Luca; F Castriota; M Kozinski; P Gurbel; C M Gibson; F Andreotti; A Buffon; J M Siller-Matula; A Sukiennik; S De Servi; J Kubica |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-20 |
Journal Detail:
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Title: Journal of thrombosis and haemostasis : JTH Volume: - ISSN: 1538-7836 ISO Abbreviation: - Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-7-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101170508 Medline TA: J Thromb Haemost Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 International Society on Thrombosis and Haemostasis. |
Affiliation:
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Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland Department of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University "A. Avogadro", Novara, Italy Interventional Cardio-Angiology Unit, GVM Care and Research, Cotignola, Italy Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland Institute of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy Department of Cardiology, Medical University of Vienna, Vienna, Austria Department of Cardiovascular Diseases, Civic Hospital, Legnano, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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