Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents.

Abstract

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.

• Authors: Yong-Jian Li, Seung-Woon Rha, Kang-Yin Chen, Kanhaiya L Poddar, Zhe Jin, Yoshiyasu Minami, Lin Wang, Qun Dang, Guang-Ping Li, Sureshkumar Ramasamy, Ji-Young Park, Cheol Ung Choi, Chol Ung Choi, Jin-Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Myung Ho Jeong, Young Keun Ahn, Taek Jong Hong, Jong-Seon Park, Young Jo Kim, Seung Ho Hur, In Whan Seong, Jei Keon Chae, Myeong Chan Cho, Jang Ho Bae, Dong Hoon Choi, Yang Soo Jang, In Ho Chae, Hyo Soo Kim, Chong Jin Kim, Jung Han Yoon, Tae Hoon Ahn, Seung-Jea Tahk, Wook Sung Chung, Ki Bae Seung, Seung Jung Park, other Korea Acute Myocardial infarction Registry Investigators
• Journal: American heart journal (Am Heart J) Vol. 159 Issue 4 Pg. 684-690.e1 (Apr 2010) ISSN: 1097-6744 [Electronic] United States
• PMID: 20362730 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: Copyright 2010 Mosby, Inc. All rights reserved.

Chemical References

• Anticoagulants
• Enoxaparin

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Anticoagulants (administration & dosage)
• Drug Therapy, Combination
• Drug-Eluting Stents
• Electrocardiography
• Enoxaparin (administration & dosage)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, therapy)
• Treatment Outcome