Summary
In randomized clinical trials the low-molecular-weight heparin enoxaparin has been
shown to reduce ischemic complications in patients with acute ST elevation myocardial
infarction (STEMI) treated with fibrinolysis. Little is known about the use and efficacy
of enoxaparin in unselected patients with STEMI in clinical practice. In a retrospective
analysis of the prospective ACOS registry we compared the outcomes of patients with
STEMI treated with enoxaparin or unfractionated heparin. A total of 6,299 patients
with STEMI < 12 hours were included in this analysis, 609 (10%) were treated with
enoxaparin and 5,690 (90%) with unfractionated heparin. In the multivariable propensity
score analysis enoxaparin was associated with a reduction in the combined endpoint
of death and non-fatal reinfarction in the entire group (odds ratio 0.59; 95% CI 0.43–0.80)
and the subgroups of patients treated without early reperfusion (odds ratio 0.65,
95% CI 0.43–0.97), fibrinolysis (odds ratio 0.64; 95% CI 0.33–1.26) and primary percutaneous
coronary intervention (odds ratio 0.33;95% CI 0.15–0.72).There was no significant
increase in severe bleeding complications with enoxaparin (6.5% versus 5.5%, p=0.4).
In clinical practice in unselected patients with STEMI treated with or without early
reperfusion therapy early treatment with enoxaparin compared to unfractionated heparin
is associated with a significant reduction of the combined endpoint of inhospital
death and reinfarction without a significant increase in severe bleeding complications.
Keywords
Acute myocardial infarction - thrombolysis / thrombolytic agents - clinical trials
- heparins / LMWH
