Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis

Johanne Silvain, Farzin Beygui, Olivier Barthélémy, Charles Pollack Jr, Marc Cohen, Uwe Zeymer, Kurt Huber, Patrick Goldstein, Guillaume Cayla, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot, Johanne Silvain, Farzin Beygui, Olivier Barthélémy, Charles Pollack Jr, Marc Cohen, Uwe Zeymer, Kurt Huber, Patrick Goldstein, Guillaume Cayla, Jean-Philippe Collet, Eric Vicaut, Gilles Montalescot

Abstract

Objective: To determine the efficacy and safety of enoxaparin compared with unfractionated heparin during percutaneous coronary intervention.

Design: Systematic review and meta-analysis.

Data sources: Medline and Cochrane database of systematic reviews, January 1996 to May 2011.

Study selection: Randomised and non-randomised studies comparing enoxaparin with unfractionated heparin during percutaneous coronary intervention and reporting on both mortality (efficacy end point) and major bleeding (safety end point) outcomes.

Data extraction: Sample size, characteristics, and outcomes, extracted independently and analysed.

Data synthesis: 23 trials representing 30,966 patients were identified, including 10,243 patients (33.1%) undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction, 8750 (28.2%) undergoing secondary percutaneous coronary intervention after fibrinolysis, and 11,973 (38.7%) with non-ST elevation acute coronary syndrome or stable patients scheduled for percutaneous coronary intervention. A total of 13,943 patients (45.0%) received enoxaparin and 17,023 (55.0%) unfractionated heparin. Enoxaparin was associated with significant reductions in death (relative risk 0.66, 95% confidence interval 0.57 to 0.76; P<0.001), the composite of death or myocardial infarction (0.68, 0.57 to 0.81; P<0.001), and complications of myocardial infarction (0.75, 0.6 to 0.85; P<0.001), and a reduction in incidence of major bleeding (0.80, 0.68 to 0.95; P=0.009). In patients who underwent primary percutaneous coronary intervention, the reduction in death (0.52, 0.42 to 0.64; P<0.001) was particularly significant and associated with a reduction in major bleeding (0.72, 0.56 to 0.93; P=0.01).

Conclusion: Enoxaparin seems to be superior to unfractionated heparin in reducing mortality and bleeding outcomes during percutaneous coronary intervention and particularly in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; the following financial relationships or activities: GC has received a research grant from la Fédération Française de Cardiologie; consultant fees from Abbott Vascular, AstraZeneca, CLS Behring, Daiichi Sankyo, Eli Lilly; lecture fees from Abbott Vascular, AstraZeneca, Biotronik, CLS Behring, Daiichi Sankyo, Eli Lilly, and Iroko Cardio. MC has received grant support and speaker honorariums from Sanofi-Aventis, Bristol-Myers Squibb, and Merck. J-PC has received research grants from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, Guerbet Medical, Medtronic, Boston Scientific, Cordis, Stago, Fondation de France, INSERM, Fédération Française de Cardiologie, and Société Française de Cardiologie; consulting fees from Sanofi-Aventis, Eli Lilly, and Bristol-Myers Squibb; and lecture fees from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, and AstraZeneca. PG has received consulting or board fees and lecture fees from AstraZeneca, Boehringer Ingelheim, Daiichi-Sankyo, Eli-Lilly, Sanofi-Aventis, and The Medicines Company. KH has received lecture fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Pfizer, Sanofi-Aventis, Schering-Plough, and The Medicines Company. GM has received support from Abbott Vascular, Boston Scientific, Cordis, Eli Lilly, Fédération Française de Cardiologie, Fondation de France, Guerbet Medical, INSERM, ITC Edison, Medtronic, Pfizer, Sanofi-Aventis, Société Française de Cardiologie, and Stago; consulting or board fees and lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Cardiovascular Research Foundation, Cleveland Clinic Research Foundation, Daiichi-Sankyo, Duke Institute, Eli Lilly, Europa, Lead-up, GlaxoSmithKline, Institut de Cardiologie de Montreal, Menarini, Nanospheres, Novartis, Pfizer, Portola, Sanofi-Aventis, The Medicines Company, and TIMI study group. CP has received research grants from Sanofi-Aventis and GlaxoSmithKline, and consulting fees from Sanofi-Aventis, and BristolMyersSquibb. JS has received research grants from Sanofi-Aventis, Daiichi-Sankyo, Eli Lilly, Brahms, INSERM, Fédération Française de Cardiologie, and Société Française de Cardiologie; consulting fees from Daiichi-Sankyo and Eli Lilly; and speaker honorariums from AstraZeneca, Daiichi Sankyo, Eli Lilly, Iroko Cardio, and Servier. EV has received consulting fees and lecture fees from Abbott, Amgen, Eli Lilly, Pfizer, Sanofi-Aventis, and Servier. UZ has received research grants and speaker honorariums from BMS, Eli Lilly, and Sanofi-Aventis; and consulting and lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Portola, and The Medicines Company; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4789891/bin/silj003078.f1_default.jpg
Fig 1 Flow of studies through review
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4789891/bin/silj003078.f2_default.jpg
Fig 2 Pooled event rates and relative risk ratios for major end points in overall cohort of patients undergoing percutaneous coronary intervention (PCI) and in subgroup of patients undergoing primary percutaneous coronary intervention. STEMI=ST elevation myocardial infarction
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4789891/bin/silj003078.f3_default.jpg
Fig 3 All cause mortality in patients undergoing percutaneous coronary intervention (PCI) treated with enoxaparin or unfractionated heparin. STEMI=ST elevation myocardial infarction; non-STE ACS=non-ST elevation acute coronary syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4789891/bin/silj003078.f4_default.jpg
Fig 4 Major bleeding in patients undergoing percutaneous coronary intervention (PCI) treated with enoxaparin or unfractionated heparin. STEMI=ST elevation myocardial infarction; non-STE ACS=non-ST elevation acute coronary syndrome

References

    1. Montalescot G, Cohen M, Salette G, Desmet WJ, Macaya C, Aylward PE, et al. Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial. Eur Heart J 2008;29:462-71.
    1. Schulz S, Mehilli J, Neumann FJ, Schuster T, Massberg S, Valina C, et al. ISAR-REACT 3A: a study of reduced dose of unfractionated heparin in biomarker negative patients undergoing percutaneous coronary intervention. Eur Heart J 2010;31:2482-91.
    1. Steg PG, Jolly SS, Mehta SR, Afzal R, Xavier D, Rupprecht HJ, et al. Low-dose vs standard-dose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: the FUTURA/OASIS-8 randomized trial. JAMA 2010;304:1339-49.
    1. Brener SJ, Moliterno DJ, Lincoff AM, Steinhubl SR, Wolski KE, Topol EJ. Relationship between activated clotting time and ischemic or hemorrhagic complications: analysis of 4 recent randomized clinical trials of percutaneous coronary intervention. Circulation 2004;110:994-8.
    1. Xiao Z, Theroux P. Platelet activation with unfractionated heparin at therapeutic concentrations and comparisons with a low-molecular-weight heparin and with a direct thrombin inhibitor. Circulation 1998;97:251-6.
    1. Montalescot G, Bal-dit-Sollier C, Chibedi D, Collet JP, Soulat T, Dalby M, et al. Comparison of effects on markers of blood cell activation of enoxaparin, dalteparin, and unfractionated heparin in patients with unstable angina pectoris or non-ST-segment elevation acute myocardial infarction (the ARMADA study). Am J Cardiol 2003;91:925-30.
    1. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113:e166-286.
    1. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010;31:2501-55.
    1. Silvain J, Beygui F, Ankri A, Bellemain-Appaix A, Pena A, Barthelemy O, et al. Enoxaparin anticoagulation monitoring in the catheterization laboratory using a new bedside test. J Am Coll Cardiol 2010;55:617-25.
    1. Montalescot G, Collet JP, Tanguy ML, Ankri A, Payot L, Dumaine R, et al. Anti-Xa activity relates to survival and efficacy in unselected acute coronary syndrome patients treated with enoxaparin. Circulation 2004;110:392-8.
    1. Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med 2006;355:1006-17.
    1. Montalescot G, Gallo R, White HD, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention 1-year results from the STEEPLE (SafeTy and efficacy of enoxaparin in percutaneous coronary intervention patients, an international randomized evaluation) trial. JACC Cardiovasc Interv 2009;2:1083-91.
    1. Montalescot G, Ellis SG, de Belder MA, Janssens L, Katz O, Pluta W, et al. Enoxaparin in primary and facilitated percutaneous coronary intervention. A formal prospective nonrandomized substudy of the FINESSE trial (Facilitated INtervention with Enhanced Reperfusion Speed to Stop Events). JACC Cardiovasc Interv 2010;3:203-12.
    1. Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P, et al. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 2011;378:693-703.
    1. Bertel O, Ramsay D, Wettstein T, Kurz DJ, Stettler I, Straumann E, et al. Intravenous enoxaparin versus unfractionated heparin in unselected patients undergoing percutaneous coronary interventions: the Zurich enoxaparin versus unfractionated heparin in PCI study (ZEUS). EuroIntervention 2010;6:407-12.
    1. Brieger D, Collet JP, Silvain J, Landivier A, Barthelemy O, Beygui F, et al. Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention. Cathet Cardiovasc Interv 2011;77:182-90.
    1. Diez JG, Medina HM, Cheong BY, O’Meallie L, Ferguson JJ. Safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention. Tex Heart Inst J 2009;36:98-103.
    1. Drozd J, Opalinska E, Wojcik J, Madejczyk A. The use of enoxaparin during percutaneous coronary angioplasty in patients with stable angina. Kardiologia polska 2001;55:520.
    1. Galeote G, Moreno R, Sanchez-Recalde A, Jimenez-Valero S, Calvo L, Rivero F, et al. [Enoxaparin vs. non-fractionated heparin in primary angioplasty of acute myocardial infarction]. Med Intensiva 2009;33:1-7.
    1. Zeymer U, Gitt A, Junger C, Koeth O, Zahn R, Wienbergen H, et al. Clinical benefit of enoxaparin in patients with high-risk acute coronary syndromes without ST elevations in clinical practice. Am J Cardiol 2006;98:19-22.
    1. Her SH, Seung KB, Yoon HJ, Kim DB, Shin DI, Lee JM, Kim PJ, et al. Prospective, randomized, preliminary clinical trial with low-molecular-weight heparin or unfractionated heparin as periprocedural anticoagulant during elective percutaneous coronary intervention. Korean Circ J 2006;36:573-7.
    1. Madan M, Radhakrishnan S, Reis M, Paradiso-Hardy FL, Godin-Edgecombe M, Sparling C, et al. Comparison of enoxaparin versus heparin during elective percutaneous coronary intervention performed with either eptifibatide or tirofiban (the ACTION Trial). Am J Cardiol 2005;95:1295-301.
    1. Bhatt DL, Lee BI, Casterella PJ, Pulsipher M, Rogers M, Cohen M, et al. Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention: results of the Coronary Revascularization Using Integrilin and Single bolus Enoxaparin Study. J Am Coll Cardiol 2003;41:20-5.
    1. Galeote G, Hussein M, Sobrino N, Calvo L, Sanchez-Recalde A, Sobrino JA. [Use of a combination of enoxaparin or unfractionated heparin and abciximab during percutaneous coronary interventions: a randomized pilot study]. Rev Esp Cardiol 2002;55:1261-6.
    1. Rabah MM, Premmereur J, Graham M, Fareed J, Hoppensteadt DA, Grines LL, et al. Usefulness of intravenous enoxaparin for percutaneous coronary intervention in stable angina pectoris. Am J Cardiol 1999;84:1391-5.
    1. Dudek D, Bartus S, Zymek P, Legutko J, Rzeszutko L, Janion M, et al. Abciximab and enoxaparin administration during elective high risk PTCA in patients with more than 3 days of ticlopidine pretreatment. J Am Coll Cardiol 2000;35:91A.
    1. Dudek D, Dabrowski M, Ochala A, Lesaik M, Wnek A, Bryniarski L, et al. Multicenter, prospective, double-blind randomized comparison of enoxaparin versus unfractionated heparin for percutaneous coronary interventions. Am J Cardiol 2000;86(suppl 8A):15i.
    1. Li YJ, Rha SW, Chen KY, Poddar KL, Jin Z, Minami Y, et al. Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents. Am Heart J 2010;159:684-90 e1.
    1. Khoobiar S, Mejevoi N, Kaid K, Boiangiu C, Setty S, Tanwir A, et al. Primary percutaneous coronary intervention for ST-elevation myocardial infarction using an intravenous and subcutaneous enoxaparin low molecular weight heparin regimen. J Thromb Thrombolysis 2008;26:85-90.
    1. Sabatine MS, Morrow DA, Montalescot G, Dellborg M, Leiva-Pons JL, Keltai M, et al. Angiographic and clinical outcomes in patients receiving low-molecular-weight heparin versus unfractionated heparin in ST-elevation myocardial infarction treated with fibrinolytics in the CLARITY-TIMI 28 Trial. Circulation 2005;112:3846-54.
    1. White HD, Kleiman NS, Mahaffey KW, Lokhnygina Y, Pieper KS, Chiswell K, et al. Efficacy and safety of enoxaparin compared with unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention in the Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial. Am Heart J 2006;152:1042-50.
    1. Dubois CL, Belmans A, Granger CB, Armstrong PW, Wallentin L, Fioretti PM, et al. Outcome of urgent and elective percutaneous coronary interventions after pharmacologic reperfusion with tenecteplase combined with unfractionated heparin, enoxaparin, or abciximab. J Am Coll Cardiol 2003;42:1178-85.
    1. Zeymer U, Gitt A, Zahn R, Junger C, Bauer T, Heer T, et al. Efficacy and safety of enoxaparin in combination with and without GP IIb/IIIa inhibitors in unselected patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention. EuroIntervention 2009;4:524-8.
    1. Gibson CM, Murphy SA, Montalescot G, Morrow DA, Ardissino D, Cohen M, et al. Percutaneous coronary intervention in patients receiving enoxaparin or unfractionated heparin after fibrinolytic therapy for ST-segment elevation myocardial infarction in the ExTRACT-TIMI 25 trial. J Am Coll Cardiol 2007;49:2238-46.
    1. Gibson CM, Morrow DA, Murphy SA, Palabrica TM, Jennings LK, Stone PH, et al. A randomized trial to evaluate the relative protection against post-percutaneous coronary intervention microvascular dysfunction, ischemia, and inflammation among antiplatelet and antithrombotic agents: the PROTECT-TIMI-30 trial. J Am Coll Cardiol 2006;47:2364-73.
    1. Cohen M, Theroux P, Borzak S, Frey MJ, White HD, Van Mieghem W, et al. Randomized double-blind safety study of enoxaparin versus unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes treated with tirofiban and aspirin: the ACUTE II study. The Antithrombotic Combination Using Tirofiban and Enoxaparin. Am Heart J 2002;144:470-7.
    1. Goodman S. Enoxaparin and glycoprotein IIb/IIIa inhibition in non-ST-elevation acute coronary syndrome: insights from the INTERACT trial. Am Heart J 2005;149:S73-80.
    1. Blazing MA, de Lemos JA, White HD, Fox KA, Verheugt FW, Ardissino D, et al. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. JAMA 2004;292:55-64.
    1. Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D, et al. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation 1999;100:1593-601.
    1. Cohen M, Demers C, Gurfinkel EP, Turpie AG, Fromell GJ, Goodman S, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med 1997;337:447-52.
    1. Danchin N, Collet J, Marco J. Use of low molecular weight heparin is associated with improved in-hospital survival of ST-elevation myocardial infarction patients who receive reperfusion therapy: results from the nationwide French FAST-MI registry. ACC Scientific Sessions; Mar 24-27, 2007; New Orleans, LA. 2007.
    1. Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, et al. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA 2004;292:45-54.
    1. Zeymer U, Gitt A, Junger C, Bauer T, Heer T, Koeth O, et al. Efficacy and safety of enoxaparin in unselected patients with ST-segment elevation myocardial infarction. Thromb Haemost 2008;99:150-4.
    1. Karsch KR, Preisack MB, Baildon R, Eschenfelder V, Foley D, Garcia EJ, et al. Low molecular weight heparin (reviparin) in percutaneous transluminal coronary angioplasty. Results of a randomized, double-blind, unfractionated heparin and placebo-controlled, multicenter trial (REDUCE trial). Reduction of Restenosis After PTCA, Early Administration of Reviparin in a Double-Blind Unfractionated Heparin and Placebo-Controlled Evaluation. J Am Coll Cardiol 1996;28:1437-43.
    1. Natarajan MK, Velianou JL, Turpie AG, Mehta SR, Raco D, Goodhart DM, et al. A randomized pilot study of dalteparin versus unfractionated heparin during percutaneous coronary interventions. Am Heart J 2006;151:175.
    1. Cucherat M, Boissel JP, Leizorovicz A, Haugh MC. EasyMA: a program for the meta-analysis of clinical trials. Comput Methods Programs Biomed 1997;53:187-90.
    1. Clarke M. The Handbook for Systematic Reviews of Interventions. Version 4.2.0. Cochrane Collaboration, 2003.
    1. Egger M, Smith GD, Phillips AN. Meta-analysis: principles and procedures. BMJ 1997;315:1533-7.
    1. Sanchez-Pena P, Hulot JS, Urien S, Ankri A, Collet JP, Choussat R, et al. Anti-factor Xa kinetics after intravenous enoxaparin in patients undergoing percutaneous coronary intervention: a population model analysis. Br J Clin Pharmacol 2005;60:364-73.
    1. Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, et al. Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes. Am Heart J 2004;147:655-61.
    1. Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V, et al. A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention. J Am Coll Cardiol 2002;40:1943-50.
    1. Silvain J, Pena A, Cayla G, Brieger D, Bellemain-Appaix A, Chastre T, et al. Impact of red blood cell transfusion on platelet activation and aggregation in healthy volunteers: results of the TRANSFUSION study. Eur Heart J 2010;31:2816-21.
    1. Rao SV, Eikelboom JA, Granger CB, Harrington RA, Califf RM, Bassand JP. Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007;28:1193-204.
    1. Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA 2003;289:853-63.
    1. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006;355:2203-16.
    1. Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008;358:2218-30.
    1. Doll JA, Nikolsky E, Stone GW, Mehran R, Lincoff AM, Caixeta A, et al. Outcomes of patients with coronary artery perforation complicating percutaneous coronary intervention and correlations with the type of adjunctive antithrombotic therapy: pooled analysis from REPLACE-2, ACUITY, and HORIZONS-AMI trials. J Interv Cardiol 2009;22:453-9.
    1. Kastrati A, Neumann FJ, Mehilli J, Byrne RA, Iijima R, Buttner HJ, et al. Bivalirudin versus unfractionated heparin during percutaneous coronary intervention. N Engl J Med 2008;359:688-96.
    1. Schulz S, Mehilli J, Neumann FJ, Schuster T, Massberg S, Valina C, et al. ISAR-REACT 3A: a study of reduced dose of unfractionated heparin in biomarker negative patients undergoing percutaneous coronary intervention. Eur Heart J 2010;31:2482-91.
    1. Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, et al. Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial. Eur Heart J 2010;31:582-7.
    1. De Luca G, Cassetti E, Vera M, Marino P. Bivalirudin as compared to unfractionated heparin among patients undergoing coronary angioplasty a meta-analyis of randomised trials. Thromb Haemost 2009;102:428-36.
    1. Navarese EP, De Luca G , Castriota F, Kozinski M, Gurbel PA, Gibson CM, et al. Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis. J Thromb Haemost 2011;9:1902-15.
    1. Mehta SR, Granger CB, Eikelboom JW, Bassand JP, Wallentin L, Faxon DP, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: results from the OASIS-5 trial. J Am Coll Cardiol 2007;50:1742-51.
    1. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA 2006;295:1519-30.
    1. Mehta SR, Steg PG, Granger CB, Bassand JP, Faxon DP, Weitz JI, et al. Randomized, blinded trial comparing fondaparinux with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention: Arixtra Study in Percutaneous Coronary Intervention: a Randomized Evaluation (ASPIRE) Pilot Trial. Circulation 2005;111:1390-7.
    1. Mehta SR, Boden WE, Eikelboom JW, Flather M, Steg PG, Avezum A, et al. Antithrombotic therapy with fondaparinux in relation to interventional management strategy in patients with ST- and non-ST-segment elevation acute coronary syndromes: an individual patient-level combined analysis of the Fifth and Sixth Organization to Assess Strategies in Ischemic Syndromes (OASIS 5 and 6) randomized trials. Circulation 2008;118:2038-46.
    1. Dumaine R, Borentain M, Bertel O, Bode C, Gallo R, White HD, et al. Intravenous low-molecular-weight heparins compared with unfractionated heparin in percutaneous coronary intervention: quantitative review of randomized trials. Arch Intern Med 2007;167:2423-30.
    1. Romagnoli E. The Radial versus Femoral Randomized Investigation in ST Elevation Acute Coronary Syndrome (RIFLE STEACS) trial. Oral presentation at the 23rd annual Transcatheter Cardiovascular Therapeutics scientific symposium. San Francisco, 10 Nov 2011.
    1. Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011;377:1409-20.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する