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Use of anticoagulants in ST-segment elevation myocardial infarction patients; a focus on low-molecular-weight heparin

Hitinder S Gurm1, Kim A Eagle

  • 1University of Michigan Cardiovascular Center, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109-5852, USA.

Cardiovascular Drugs and Therapy
|January 1, 2008
PubMed

Insights

Low-molecular-weight heparins (LMWHs) like enoxaparin show improved outcomes for ST-segment elevation myocardial infarction (STEMI) patients treated with thrombolytics, though bleeding risks exist. Enoxaparin is the only LMWH approved by the FDA for STEMI management.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI).
  • Logistical challenges mean many STEMI patients still receive thrombolytics.
  • Unfractionated heparin (UFH) is the standard anticoagulant for thrombolytic therapy in STEMI, but alternatives are being explored.

Purpose of the Study:

  • To review evidence on alternative anticoagulants for STEMI patients treated with thrombolysis.
  • To compare the efficacy and safety of low-molecular-weight heparins (LMWHs), fondaparinux, and bivalirudin against UFH.

Main Methods:

  • Systematic review of randomized controlled trials involving anticoagulants in STEMI patients treated with thrombolysis.
  • Analysis of clinical efficacy endpoints and bleeding events.

Main Results:

  • Low-molecular-weight heparins (LMWHs) have the most accumulated evidence among alternative anticoagulants.
  • Enoxaparin and reviparin demonstrated improved clinical efficacy endpoints, but with increased bleeding.
  • Dalteparin trials did not show improved efficacy compared to UFH.

Conclusions:

  • Enoxaparin is the only FDA-approved LMWH for STEMI patients receiving fibrinolysis.
  • Enoxaparin represents a preferable alternative to UFH in this patient population.
Abstract

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