Abstract | OBJECTIVES: BACKGROUND: The efficacy and safety of ENOX and clopidogrel given together in STEMI remains to be defined. METHODS: RESULTS:
Enoxaparin significantly reduced the rate of the composite of death, recurrent myocardial infarction, myocardial ischemia, or stroke, compared with UFH, both in patients (n = 2,173) treated with clopidogrel (10.8% vs. 13.9%, adjusted odds ratio [OR(adj)] 0.70, p = 0.013) and in patients (n = 12,918) not treated with clopidogrel (13.3% vs. 15.3%, OR(adj) 0.85, p = 0.003) with no evidence of heterogeneity (p(interaction) = 0.21). The excess risk of TIMI major bleeding with ENOX versus UFH was numerically but not statistically significantly higher in patients treated with clopidogrel (2.7% vs. 1.0%) versus those who were not (2.1% vs. 1.2%) (p(interaction) = 0.61). Net clinical benefit ( MACE and major bleeding) favored treatment with ENOX over UFH, either with concomitant clopidogrel (absolute risk reduction 2.4%, 95% confidence interval [CI] -0.5% to 5.3%) or without (absolute risk reduction 1.7%, 95% CI 0.5% to 3.0%) (p(interaction) = 0.61). CONCLUSIONS: In patients with STEMI receiving fibrinolytic therapy, the net benefit of ENOX is similar in patients who are and are not treated with clopidogrel. The totality of trial data suggest that the combination of a fibrinolytic, aspirin, clopidogrel, and ENOX offers an attractive pharmacologic reperfusion strategy in STEMI.
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Authors | Marc S Sabatine, David A Morrow, Anthony Dalby, Mathias Pfisterer, Tibor Duris, Jose Lopez-Sendon, Sabina A Murphy, Runlin Gao, Elliott M Antman, Eugene Braunwald, ExTRACT-TIMI 25 Investigators |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 49
Issue 23
Pg. 2256-63
(Jun 12 2007)
ISSN: 1558-3597 [Electronic] United States |
PMID | 17560290
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Enoxaparin
- Fibrinolytic Agents
- Platelet Aggregation Inhibitors
- Heparin
- Clopidogrel
- Ticlopidine
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Topics |
- Aged
- Clopidogrel
- Double-Blind Method
- Drug Therapy, Combination
- Enoxaparin
(adverse effects, therapeutic use)
- Female
- Fibrinolytic Agents
(adverse effects, therapeutic use)
- Heparin
(adverse effects, therapeutic use)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(drug therapy)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Thrombolytic Therapy
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Treatment Outcome
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