EXTRACT–TIMI 25 (Enoxaparin andThrombolysis Reperfusion for AcuteMyocardial Infarction Treatment—Thrombolysis in Myocardial Infarction 25)
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
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
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)
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