Efficacy and safety of two unfractionated heparin dosing strategies with tenecteplase in acute myocardial infarction (results from Assessment of the Safety and Efficacy of a New Thrombolytic Regimens 2 and 3).

Abstract

We investigated the effect of smaller dose, weight-adjusted heparin with earlier monitoring of activated partial thromboplastin time on the incidence of ischemic and hemorrhagic complications in patients with ST-elevation myocardial infarction treated with full-dose tenecteplase. We compared the outcomes of patients enrolled in the Second Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-2; n = 8,461) who received heparin stratified by weight (patients weighing >67 kg received a 5,000-U bolus plus infusion at 1,000 U/hour; those weighing < or =67 kg received a 4,000-U bolus plus infusion at 800 U/hour) with patients in ASSENT-3 who received weight-adjusted heparin (60-U/kg bolus, maximum 4,000 U/hour, followed by a 12-U/kg/hour infusion, maximum 1,000 U/hour). Compared with patients in ASSENT-2, those in ASSENT-3 had similar rates of 30-day mortality, recurrent infarction, and intracranial hemorrhage, less major bleeding (2.2% vs 4.7%, p <0.001), and less refractory ischemia (6.5% vs 8.6%, p <0.001). After adjustment for baseline characteristics, patients in ASSENT-3 had similar rates of 30-day mortality (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.77 to 1.19) and intracranial hemorrhage (OR 1.02, 95% CI 0.61 to 1.69) but less major bleeding (OR 0.49, 95% CI 0.35 to 0.67) than did patients in ASSENT-2. These findings support the use of smaller dose, weight-adjusted heparin in patients with ST-elevation myocardial infarction treated with tenecteplase.

• Authors: Jeptha P Curtis, John H Alexander, Yao Huang, Lars Wallentin, Freek W A Verheugt, Paul W Armstrong, Harlan M Krumholz, Frans Van de Werf, Thierry Danays, Morris Cheeks, Christopher B Granger, ASSENT-2 and ASSENT-3 Investigators
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 94 Issue 3 Pg. 279-83 (Aug 01 2004) ISSN: 0002-9149 [Print] United States
• PMID: 15276088 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Heparin, Low-Molecular-Weight
• Tissue Plasminogen Activator
• Tenecteplase

Topics

• Aged
• Confidence Intervals
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Therapy, Combination
• Electrocardiography
• Female
• Follow-Up Studies
• Heparin, Low-Molecular-Weight (administration & dosage, adverse effects)
• Humans
• Incidence
• Intracranial Hemorrhages (chemically induced, epidemiology)
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (diagnosis, drug therapy, mortality)
• Myocardial Ischemia (chemically induced, epidemiology)
• Partial Thromboplastin Time
• Probability
• Randomized Controlled Trials as Topic
• Risk Assessment
• Severity of Illness Index
• Survival Rate
• Tenecteplase
• Thrombolytic Therapy (methods)
• Tissue Plasminogen Activator (administration & dosage, adverse effects)
• Treatment Outcome