依诺肝素与普通肝素在联合纤溶疗法治疗ST段抬高型心肌梗死中作用的比较  

Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction

作　　者：Antman E.M. Morrow D.A. McCabe C.H. 杜媛 

机构地区：[1]TIMI Study Group,Cardiovascular Division,Brigham and Women's Hospital,75 Francis St.,Boston,MA 02115,United States,Dr

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第9期7-8,共2页

摘　　要：BACKGROUND: Unfractionated heparin is often used as adjunctive therapy with fibrinolysis in patients with ST-elevation myocardial infarction. We compared a low-molecular-weight heparin, enoxaparin, with unfractionated heparin for this purpose. METHODS: We randomly assigned 20,506 patients with ST-elevation myocardial infarction who were scheduled to undergo fibrinolysis to receive enoxaparin throughout the index hospitalization or weight-based unfractionated heparin for at least 48 hours. The primary efficacy end point was death or nonfatal recurrent myocardial infarction through 30 days. RESULTS: The primary end point occurred in 12.0 percent of patients in the unfractionated heparin group and 9.9 percent of those in the enoxaparin group(17 percent reduction in relative risk, P< 0.001). Nonfatal reinfarction occurred in 4.5 percent of the patients receiving unfractionated heparin and 3.0 percent of those receiving enoxaparin(33 percent reduction in relative risk, P< 0.001); 7.5 percent of patients given unfractionated heparin died, as did 6.9 percent of those given enoxaparin(P=0.11). The composite of death, nonfatal reinfarction, or urgent revascularization occurred in 14.5 percent of patients given unfractionated heparin and 11.7 percent of those given enoxaparin(P< 0.001); major bleeding occurred in 1.4 percent and 2.1 percent, respectively(P< 0.001). The composite of death, nonfatal reinfarction, or nonfatal intracranial hemorrhage(a measure of net clinical benefit) occurred in 12.2 percent of patients given unfractionated heparin and 10.1 percent of those given enoxaparin(P< 0.001). CONCLUSIONS: In patients receiving fibrinolysis for ST-elevation myocardial infarction, treatment with enoxaparin throughout the index hospitalization is superior to treatment with unfractionated heparin for 48 hours but is associated with an increase in major bleeding episodes. These findings should be interpreted in the context of net clinical benefit.BACKGROUND： Unfractionated heparin is often used as adjunctive therapy with fibrinolysis in patients with ST-elevation myocardial infarction. We compared a low-molecular-weight heparin, enoxaparin, with unfractionated heparin for this purpose. METHODS： We randomly assigned 20, 506 patients with ST-elevation myocardial infarction who were scheduled to undergo fibrinolysis to receive enoxaparin throughout the index hospitalization or weight-based unfractionated heparin for at least 48 hours, The primary efficacy end point was death or nonfatal recurrent myocardial infarction through 30 days. RESULTS： The primary end point occurred in 12.0 percent of patients in the unfractionated heparin group and 9. 9 percent of those in the enoxaparin group（17 percent reduction in relative risk, P 〈 0. 001 ） . Nonfatal reinfarction occurred in 4. 5 percent of the patients receiving unfractionated heparin and 3.0 percent of those receiving enoxaparin（33 percent reduction in relative risk, P 〈 0. 001）; 7.5 percent of patients given unfractionated heparin died, as did 6.9 percent of those given enoxaparin（P =0. 11） The composite of death, nonfatal reinfaretion, or urgent revascularization occurred in 14. 5 percent of patients given unfractionated heparin and 11.7 percent of those given enoxaparin（P 〈 0. 001）; major bleeding occurred in 1.4 percent and 2. 1 percent, respectively（P 〈 0. 001） .

关 键 词：ST段抬高型 心肌梗死患者 普通肝素 依诺肝素 辅助治疗 纤溶疗法 非致死性 再发心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]