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EXTRACT-TIMI 25 trial - Summary & Results
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EXTRACT-TIMI 25 trial - Summary & Results

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http://www.theheart.org/web_slides/1136041.do …

http://www.theheart.org/web_slides/1136041.do

A randomized sutdy on EXTRACT-TIMI 25 with patients with STEMI scheduled for fibrinolysis receiving enoxaparin or UFH for at least 48 hours

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  • 1. EXTRACT–TIMI 25 (Enoxaparin andThrombolysis Reperfusion for AcuteMyocardial Infarction Treatment—Thrombolysis in Myocardial Infarction 25)
  • 2. EXTRACT–TIMI 25 (Enoxaparin and ThrombolysisReperfusion for Acute Myocardial Infarction Treatment—Thrombolysis in Myocardial Infarction 25)EM Antman (Brigham and Women’s Hospital, Boston, MA)American College of Cardiology 2006 Scientific Sessions• Background: The use of UFH requires frequent monitoring to adjust infusion rate to maintain a therapeutic range of anticoagulation LMWHs such as enoxaparin provide a reliable level of anticoagulation without the need for therapeutic monitoring and offer the advantage of subcutaneous administration• Population and treatment: 20 506 patients with STEMI scheduled for fibrinolysis randomized to receive enoxaparin or UFH for at least 48 hours• Primary outcome: Death or nonfatal recurrent MI through 30 daysUFH=unfractionated heparinLMWH=low-molecular-weight heparin
  • 3. EXTRACT–TIMI 25: Results• Primary end point significantly reduced in the enoxaparin arm—primarily driven by a 33% reduction in nonfatal MIOutcomes at 30 daysOutcome Enoxaparin UFH Relative p (n=10 256), (n=10 223) risk n (%) n, (%)Primary end point 1017 (9.9) 1223 (12.0) 0.83 <0.001Death 708 (6.9) 765 (7.5) 0.92 0.11Nonfatal MI 309 (3.0) 458 (4.5) 0.67 <0.001Urgent revascularization 213 (2.1) 286 (2.8) 0.74 <0.001Death, nonfatal MI, or urgent revascularization 1199 (11.7) 1479 (14.5) 0.81 <0.001Major bleeding (including ICH) 211 (2.1) 138 (1.4) 1.53 <0.001Net clinical benefit: death, nonfatal MI, or nonfatal ICH 1040 (10.1) 1250 (12.2) 0.83 <0.001Net clinical benefit: death, nonfatal MI, or nonfatal major bleeding 1128 (11.0) 1305 (12.8) 0.86 <0.001ICH=intracerebral hemorrhage
  • 4. EXTRACT–TIMI 25: Commentary*"EXTRACT–TIMI 25 appears to confirm a recent meta-analysis that showed anadvantage of low-molecular-weight heparin [LMWH] over UFH in lytic patients, butwith one major caveat—enoxaparin was given for seven days whereas UFH wasgiven for only two." - Dr Eric Bates"The one message I have received most clearly from [this trial] is that we nowknow it is safe to use enoxaparin with thrombolysis in the elderly if we reduce thedose." - Dr Paul Armstrong *All comments from Experts clash over relative benefits of enoxaparin and fondaparinux in EXTRACT– TIMI 25 and OASIS–6 (http://www.theheart.org/article/674653.do)
  • 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.