Clinical InvestigationsAcute Ischemic Heart DiseaseAdjunctive benefits from low-molecular-weight heparins as compared to unfractionated heparin among patients with ST-segment elevation myocardial infarction treated with thrombolysis. A meta-analysis of the randomized trials
Section snippets
Eligibility and search strategy
We obtained results from all RTs on adjunctive LMWHs as compared to UFH among patients with STEMI treated with thrombolysis. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL) from January 1990 to June 2007 and scientific session abstracts in Circulation, Journal of College of Cardiology, European Heart Journal, and American Journal of Cardiology from January 1990 to June 2007. Furthermore, oral presentations and/or expert slide presentations were
Results
We identified a total of 8 RTs (Table I),9, 10, 11, 12, 13, 14, 15, 16 including 13 940 patients randomized to LMWHs and 13 818 to UFH. Three studies used tenecteplase,9, 11, 12, 13, 14 2 alteplase,10, 13 1 streptokinase,14 1 urokinase,16 a mixture in the EXTRACT-TIMI 25.15 One study did not administer aspirin until the fourth day16; the remaining studies for which this information was available administered at least 150 mg initially.9, 12, 13, 14, 15, 16 The maintenance dose of aspirin was
Discussion
The results of our meta-analysis of 8 RTs, including 27 758 patients, show that LMWHs are associated with a significant reduction in reinfarction, trend in benefits in mortality, but higher risk of major bleeding complications.
Even though the benefits in mortality and reinfarction with UFH have not been proven, intravenous UFH remains a pivotal antithrombotic therapy among patients with STEMI, particularly in Western countries in which fibrin-specific thrombolytic agents are widely used,17, 18
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