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Unfractionated heparin-clopidogrel combination in ST-elevation myocardial infarction not receiving reperfusion therapy.
2015, Atherosclerosis. 2015 Apr 27;241(1):151-156. doi: 10.1016/j.atherosclerosis.2015.04.794. [Epub ahead of print]
Autors del centre relacionats: Badimon Lina.
Autors del centre relacionats: Badimon Lina.
Bugiardini R1, Dorobantu M2, Vasiljevic Z3, Kedev S4, Kne?ević B5, Miličić D6, Calmac L2, Trninic D7, Daullxhiu I8, Cenko E9, Ricci B9, Puddu PE10, Manfrini O9, Koller A11, Badimon L12; ISACS-TC Investigators.
Author information
1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy. Electronic address: [email protected].
2Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania.
3Clinical Center of Serbia, University of Belgrade, Serbia.
4University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia.
5Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
6Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia.
7Clinical Center of Banja Luka, Republika Srpska, Bosnia and Herzegovina.
8Department of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
9Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
10Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
11Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, USA.
12Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, CiberObn-Institute Carlos III, Autonomous University of Barcelona, Spain.
Abstract
OBJECTIVE:
We sought explore the relative benefits of unfractionated heparin (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in ST-segment elevation myocardial infarction (STEMI) patients not undergoing reperfusion therapy.
METHODS:
This is a propensity score study from The International Survey on Acute Coronary Syndromes in Transition Countries (ISACS-TC/NCT01218776) on patients admitted between October 2010-June 2013. There were a total of 1175 STEMI patients who did not receive mechanical or pharmacological reperfusion. Of these, 1063 were eligible for the aim of the study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) patients. The primary endpoint was in-hospital mortality. Secondary endpoints were intracranial hemorrhages, and clinically relevant bleedings.
RESULTS:
After adjustment for any confounders, UFH was associated with a lower risk of in-hospital mortality in clopidogrel users (multivariate adjusted regression analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41-0.94) as compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55-1.60). The observed effect was not associated with combined enoxaparin and clopidogrel therapy. Major bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 1.5% respectively, p = 0.06). The risk of major hemorrhage was nearly similar with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), p = 0.67.
CONCLUSION:
UFH - Clopidogrel combination was associated with a large mortality reduction in STEMI patients not undergoing reperfusion therapy and did not significantly increase the risk of major bleeding.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
KEYWORDS:
Clopidogrel; Enoxaparin; No-reperfusion therapy; Outcomes; ST-segment elevation myocardial infarction; Unfractionated heparin
PMID: 25988359 [PubMed - as supplied by publisher]
Author information
1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy. Electronic address: [email protected].
2Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania.
3Clinical Center of Serbia, University of Belgrade, Serbia.
4University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia.
5Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
6Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia.
7Clinical Center of Banja Luka, Republika Srpska, Bosnia and Herzegovina.
8Department of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.
9Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
10Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
11Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, USA.
12Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, CiberObn-Institute Carlos III, Autonomous University of Barcelona, Spain.
Abstract
OBJECTIVE:
We sought explore the relative benefits of unfractionated heparin (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in ST-segment elevation myocardial infarction (STEMI) patients not undergoing reperfusion therapy.
METHODS:
This is a propensity score study from The International Survey on Acute Coronary Syndromes in Transition Countries (ISACS-TC/NCT01218776) on patients admitted between October 2010-June 2013. There were a total of 1175 STEMI patients who did not receive mechanical or pharmacological reperfusion. Of these, 1063 were eligible for the aim of the study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) patients. The primary endpoint was in-hospital mortality. Secondary endpoints were intracranial hemorrhages, and clinically relevant bleedings.
RESULTS:
After adjustment for any confounders, UFH was associated with a lower risk of in-hospital mortality in clopidogrel users (multivariate adjusted regression analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41-0.94) as compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55-1.60). The observed effect was not associated with combined enoxaparin and clopidogrel therapy. Major bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 1.5% respectively, p = 0.06). The risk of major hemorrhage was nearly similar with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), p = 0.67.
CONCLUSION:
UFH - Clopidogrel combination was associated with a large mortality reduction in STEMI patients not undergoing reperfusion therapy and did not significantly increase the risk of major bleeding.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
KEYWORDS:
Clopidogrel; Enoxaparin; No-reperfusion therapy; Outcomes; ST-segment elevation myocardial infarction; Unfractionated heparin
PMID: 25988359 [PubMed - as supplied by publisher]
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