Enoxaparin versus Unfractionated Heparin as Adjunctive Anticoagulant Therapy in Patients Treated with Primary Percutaneuous Coronary Intervention for ST-Elevation Myocardial Infarction
1Dongguk University Gyeongju Hospital, Gyeongju, Korea (Republic of); 2Dongguk Uinversity Illsan Hospital, Illsan, Korea (Republic of)
Background: Enoxaparine (ENOX) has shown to be more effective than unfractionated heparin (UFH) for ST-segment elevation myocardial infarction (STEMI) patients treated with fibrinolysis. However, controversies remain regarding the safety and efficacy of ENOX as adjunctive anticoagulant therapy in patients treated with primary percutaneous coronary intervention (PCI) for STEMI.
Methods: Between January 2005 and April 2007, 130 patients were admitted for STEMI and primary PCI was performed. We divided the patients into 2 groups with either ENOX (n = 53) or UFH (n = 77) used as the adjunctive anticoagulant. The incidence of thrombolysis in myocardial Infarction (TIMI) major or minor bleeding at 48 hours and 8 days and the incidence of major adverse cardiac events (MACE: cardiac death, non-fatal myocardial infarction, urgent target vessel revascularization) at 1 month were evaluated.
Results: See Table. Baseline patient characteristics were similar between the 2 groups. There was similar incidence of TIMI major and minor bleeding between 2 groups at 48 hours and 8 days. The incidence of MACE was similar between 2 groups at 1 month follow up.
Enox
UFH
Subtoal
No. of Cases
%
Subtoal
No. of Cases
%
P-value
30 days MACE
51
4
7.8
74
11
14.9
0.235*
48 hours Major or Minor bleeding
53
3
5.7
77
0
0
0.065˘Ó
8 days Major or Minor bleeding
53
4
7.5
77
5
6.5
1.000˘Ó
* by Chi-square test˘Ó by FisherĄŻs exact test
Conclusion: Enox may be safe as adjunctive anticoagulant during primary PCI in patients with STEMI without increasing MACE compared with UFH. This was a preliminary study to evaluate the safety and efficacy of ENOX as anticoagulant during primary PCI in patients with STEMI. Prospective and randomized large-scale studies are essential.
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