Enoxaparin plus clot dissolver shows results
Heart attack patients treated with enoxaparin and a clot dissolver were significantly less likely to die or have repeat heart attacks within 30 days compared to patients who received unfractionated heparin (UFH), according to a Rapid Track article published in Circulation.
"We have very encouraging data, but the evidence is not yet sufficient to say that enoxaparin should be standard treatment for severe heart attacks," says Elliott Antman, MD, associate professor of medicine at Harvard Medical School in Cambridge and director of the coronary care unit of Brigham and Women’s Hospital in Boston. "However, the data suggest we should pursue a larger clinical trial."
The 483 patients who participated in the ENTIRE-TIMI 23 study presented with ST-segment elevated MI. They were randomly assigned to either standard reperfusion with full-dose tenecteplase (TNK) or combination therapy with abciximab and a half-dose of TNK and either UFH or enoxaparin.
Researchers evaluated reperfusion by the TIMI grading system, in which a 0 score means no flow through an artery, and a 3 score means normal flow. The study also monitored ST-segment resolution, the effect of treatment on the risk of death or recurrent heart attack within 30 days, and the occurrence of major bleeding within 30 days.
While UFH and enoxaparin showed nearly identical rates of TIMI-3 flow at 60 minutes, only 4.4% of the enoxaparin-TNK patients had died at the 30-day analysis, as compared to 15.9% of patients who received UFH-TNK. The rates were 6.5% with UFH-abciximab-TNK and 5.5% with enoxaparin-abciximab-TNK. The rate of major bleeding was 2.4% with full-dose UFH-TNK and 1.9% in the enoxaparin-TNK patients. In the combination therapy patients, the rate of major bleeding was 5.2% with UFH and 8.5% with enoxaparin.
Antman expects a new study, ExTRACT-TIMI 25, to help answer the question of whether enoxaparin should replace UFH in heart attack treatment.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content