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

Title
Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents
Author(s)
김영조리용지안[리용지안]라성운[라성운]천강인[천강인]포달 칸하이야 L.[포달 칸하이야 L.]쯔진[쯔진]요시야수 미나미[요시야수 미나미]린왕[린왕]쿤당[쿤당]리구앙핑[리구앙핑]수레쉬쿠마 라마사미[수레쉬쿠마 라마사미]박지영[박지영]최철옹[최철옹]김진원[김진원]김응주[김응주]박창규[박창규]서홍성[서홍성]오동주[오동주]정명호[정명호]안영근[안영근]홍택종[홍택종]박종선허성호[허성호]성인환[성인환]채재근[채재근]조명찬[조명찬]배장호[배장호]최동훈[최동훈]장양수[장양수]채인호[채인호]김효수[김효수]김종진[김종진]윤정한[윤정한]안태훈[안태훈]탁성재[탁성재]청욱성[청욱성]성기배[성기배]박성중[박성중]
Keywords
RANDOMIZED-TRIALS; CLINICAL-PRACTICE; PLATELET-FUNCTION; ENOXAPARIN; THROMBOSIS; THERAPY; METAANALYSIS; ANGIOPLASTY; CLOPIDOGREL; EFFICACY
Issue Date
201004
Publisher
MOSBY-ELSEVIER
Citation
AMERICAN HEART JOURNAL, v.159, no.4, pp.684 - U218
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. (Am Heart J 2010; 159: 684-690. e1.)
URI
http://hdl.handle.net/YU.REPOSITORY/22645http://dx.doi.org/10.1016/j.ahj.2009.12.041
ISSN
0002-8703
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의과대학 > 내과학교실 > Articles
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