Circulation. 2002;105:1642-1649
Published online before print March 4, 2002, doi: 10.1161/01.CIR.0000013402.34759.46
Published online before print March 4, 2002, doi: 10.1161/01.CIR.0000013402.34759.46
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(Circulation. 2002;105:1642.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Enoxaparin as Adjunctive Antithrombin Therapy for ST-Elevation Myocardial Infarction
Results of the ENTIRE-Thrombolysis in Myocardial Infarction (TIMI) 23 Trial
From Brigham and Women’s Hospital (E.M.A., E.B.), Harvard Clinical Research Institute (C.M.G.), Boston, Mass; Medisch Spectrum Twente (H.W.L.), Enschede; TweeSteden Ziekenhuis (H.F.B.), Tilburg; Spaarne Ziekenhuis (J.C.L.W.), Heemstede; Eemland Ziekenhuis "de Lichtenberg" (B.H.), Amersfoort, the Netherlands; CHU Jean Minjoz (J.-P.B.), Besancon, France; Universitair Ziekenhuis Gasthuisberg (H.H., F.V.d.W.), Leuven, Belgium; and Aventis Pharma (F.B., G.P.), Antony, France.
Correspondence to Elliott M. Antman, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA. E-mail eantman{at}rics.bwh.harvard.edu
Background— ENTIRE-TIMI 23 evaluated enoxaparin with full-dose tenecteplase (TNK) and half-dose TNK plus abciximab.
Methods and Results— Patients (n=483) with ST-elevation MI presenting <6 hours from symptom onset were randomized to full-dose TNK and either unfractionated heparin (UFH) (bolus 60 U/kg; infusion 12 U/kg per hour) or enoxaparin (1.0 mg/kg subcutaneously every 12 hours±initial 30 mg intravenous bolus), or half-dose TNK plus abciximab and either UFH (bolus 40 U/kg; infusion 7 U/kg per hour) or enoxaparin (0.3 to 0.75 mg/kg subcutaneously every 12 hours±initial intravenous bolus of 30 mg). With full-dose TNK and UFH, the rate of TIMI 3 flow at 60 minutes was 52% and was 48% to 51% with enoxaparin. Using combination therapy, the rate of TIMI 3 flow was 48% with UFH and 47% to 58% with enoxaparin. The rate of TIMI 3 flow among all UFH patients was 50% and was 51% among enoxaparin patients. Through 30 days, death/recurrent MI occurred in the full-dose TNK group in 15.9% of patients with UFH and 4.4% with enoxaparin (P=0.005). In the combination therapy group, the rates were 6.5% with UFH and 5.5% with enoxaparin. The rate of major hemorrhage with full-dose TNK was 2.4% with UFH and 1.9% with enoxaparin; with combination therapy, it was 5.2% using UFH and 8.5% with enoxaparin.
Conclusions— Enoxaparin is associated with similar TIMI 3 flow rates as UFH at an early time point while exhibiting advantages over UFH with respect to ischemic events through 30 days. These findings with enoxaparin are achieved with a similar risk of major hemorrhage.
Key Words: fibrinolysis • myocardial infarction • heparin • anticoagulants
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