Abstract | BACKGROUND: METHODS AND RESULTS: In the Enoxaparin and Thrombolysis in Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 study, 20 506 patients with ST-segment elevation myocardial infarction were randomized to enoxaparin or unfractionated heparin, the latter dosed according to the American College of Cardiology/American Heart Association weight-based nomogram with centrally monitored activated partial thromboplastin times (aPTTs). A total of 6055 patients received study unfractionated heparin and a fibrin-specific lytic and had an initial aPTT drawn within 4 to 8 hours of starting therapy. Despite close adherence to recommended dosing, only 33.8% of initial aPTTs were therapeutic (1.50 to 2.00 times control); 13.2% were markedly low (<1.25 times); and 16.3% were markedly high (> or =2.75 times). Markedly high aPTTs were more likely in patients who were older (adjusted risk ratio [RR(adj)], 1.14 per decade; P=0.001), were female (RR(adj), 1.46; P<0.001), were of lower weight (RR(adj), 1.19 per 10-kg decrease; P<0.001) or had renal dysfunction (RR(adj), 1.08 per 0.2-mg/dL increase in serum creatinine; P=0.006). Markedly high aPTTs were associated with increased risk of TIMI major or minor bleeding by 48 hours (odds ratio, 2.11; P=0.004); markedly low aPTTs tended to be associated with increased risk of fatal or nonfatal reinfarction by 48 hours (odds ratio, 2.19; P=0.057). CONCLUSIONS:
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Authors | Susan Cheng, David A Morrow, Sarah Sloan, Elliott M Antman, Marc S Sabatine |
Journal | Circulation
(Circulation)
Vol. 119
Issue 9
Pg. 1195-202
(Mar 10 2009)
ISSN: 1524-4539 [Electronic] United States |
PMID | 19237657
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Enoxaparin
- Heparin
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Topics |
- Aged
- Aged, 80 and over
- Anticoagulants
(administration & dosage, adverse effects)
- Blood Coagulation
(drug effects)
- Coronary Artery Disease
(drug therapy)
- Coronary Thrombosis
(prevention & control)
- Electrocardiography
- Enoxaparin
(administration & dosage, adverse effects)
- Female
- Heparin
(administration & dosage, adverse effects)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(diagnosis, drug therapy)
- Partial Thromboplastin Time
- Predictive Value of Tests
- Treatment Outcome
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