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Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis

  1. E. P. NAVARESE1,
  2. G. DE LUCA2,
  3. F. CASTRIOTA3,
  4. M. KOZINSKI1,
  5. P.A. GURBEL4,
  6. C. M. GIBSON5,
  7. F. ANDREOTTI6,
  8. A. BUFFON6,
  9. J. M. SILLER-MATULA7,
  10. A. SUKIENNIK1,
  11. S. DE SERVI8,
  12. J. KUBICA1

Article first published online: 29 SEP 2011

DOI: 10.1111/j.1538-7836.2011.04445.x

Issue

Journal of Thrombosis and Haemostasis

Journal of Thrombosis and Haemostasis

Volume 9, Issue 10, pages 1902–1915, October 2011

Additional Information

How to Cite

NAVARESE, E. P., DE LUCA, G., CASTRIOTA, F., KOZINSKI, M., GURBEL, P.A., GIBSON, C. M., ANDREOTTI, F., BUFFON, A., SILLER-MATULA, J. M., SUKIENNIK, A., DE SERVI, S. and KUBICA, J. (2011), Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis. Journal of Thrombosis and Haemostasis, 9: 1902–1915. doi: 10.1111/j.1538-7836.2011.04445.x

Author Information

  1. 1

    Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

  2. 2

    Department of Cardiology, “Maggiore della Carità” Hospital, Eastern Piedmont University “A. Avogadro”, Novara

  3. 3

    Interventional Cardio-Angiology Unit, GVM Care and Research, Cotignola, Italy

  4. 4

    Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, MD

  5. 5

    Institute of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

  6. 6

    Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy

  7. 7

    Department of Cardiology, Medical University of Vienna, Vienna, Austria

  8. 8

    Department of Cardiovascular Diseases, Civic Hospital, Legnano, Italy

*Eliano Pio Navarese, Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Skodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland. Tel.: +48 52 585 40 23; fax: +48 52 585 40 24. E-mail: eliano.navarese@alice.it

Publication History

  1. Issue published online: 29 SEP 2011
  2. Article first published online: 29 SEP 2011
  3. Accepted manuscript online: 20 JUL 2011 11:35AM EST
  4. Received 20 April 2011, accepted 11 July 2011

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Keywords:

  • low-molecular-weight heparin;
  • percutaneous coronary intervention;
  • ST-elevation myocardial infarction;
  • unfractionated heparin

Summary. Background: The aim of the current study was to perform two separate meta-analyses of available studies comparing low-molecular-weight heparins (LMWHs) vs. unfractionated heparin (UFH) in ST-elevation myocardial infarction (STEMI) patients treated (i) with primary percutaneous coronary intervention (pPCI) or (ii) with PCI after thrombolysis. Methods: All-cause mortality was the pre-specified primary endpoint and major bleeding complications were recorded as the secondary endpoints. Relative risk (RR) with a 95% confidence interval (CI) and absolute risk reduction (ARR) were chosen as the effect measure. Results: Ten studies comprising 16 286 patients were included. The median follow-up was 2 months for the primary endpoint. Among LMWHs, enoxaparin was the compound most frequently used. In the pPCI group, LMWHs were associated with a reduction in mortality [RR (95% CI) = 0.51 (0.41–0.64), P < 0.001, ARR = 3%] and major bleeding [RR (95% CI) = 0.68 (0.49–0.94), P = 0.02, ARR = 2.0%] as compared with UFH. Conversely, no clear evidence of benefits with LWMHs was observed in the PCI group after thrombolysis. Meta-regression showed that patients with a higher baseline risk had greater benefits from LMWHs (r = 0.72, P = 0.02). Conclusions: LMWHs were associated with greater efficacy and safety than UFH in STEMI patients treated with pPCI, with a significant relationship between risk profile and clinical benefits. Based on this meta-analysis, LMWHs may be considered as a preferred anticoagulant among STEMI patients undergoing pPCI.

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