Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

Yong Jian Li, Seung-Woon Rha, Kang Yin Chen, Kanhaiya L. Poddar, Zhe Jin, Yoshiyasu Minami, Lin Wang, Qun Dang, Guang Ping Li, Sureshkumar Ramasamy, Ji Young Park, Cheol Ung Choi, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Myung Ho Jeong, Young Keun Ahn, Taek Jong Hong & 18 others Jong Seon Park, Young Jo Kim, Seung Ho Hur, In Whan Seong, Jei Keon Chae, Myeong Chan Cho, Jang Ho Bae, Dong Hoon Choi, Yang Soo Jang, In Ho Chae, Hyo Soo Kim, Chong Jin Kim, Jung Han Yoon, Tae Hoon Ahn, Seung Jea Tahk, Wook Sung Chung, Ki Bae Seung, Seung Jung Park

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Abstract

Background: Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. Methods: A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex. Conclusions: The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.

Original languageEnglish
JournalAmerican Heart Journal
Volume159
Issue number4
DOIs
Publication statusPublished - 2010 Apr 1

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Drug-Eluting Stents
Low Molecular Weight Heparin
Percutaneous Coronary Intervention
Heparin
Enoxaparin
Odds Ratio
Myocardial Infarction
Hemorrhage
Incidence
Intravenous Injections
Randomized Controlled Trials
Regression Analysis
ST Elevation Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents. / Li, Yong Jian; Rha, Seung-Woon; Chen, Kang Yin; Poddar, Kanhaiya L.; Jin, Zhe; Minami, Yoshiyasu; Wang, Lin; Dang, Qun; Li, Guang Ping; Ramasamy, Sureshkumar; Park, Ji Young; Choi, Cheol Ung; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Jeong, Myung Ho; Ahn, Young Keun; Hong, Taek Jong; Park, Jong Seon; Kim, Young Jo; Hur, Seung Ho; Seong, In Whan; Chae, Jei Keon; Cho, Myeong Chan; Bae, Jang Ho; Choi, Dong Hoon; Jang, Yang Soo; Chae, In Ho; Kim, Hyo Soo; Kim, Chong Jin; Yoon, Jung Han; Ahn, Tae Hoon; Tahk, Seung Jea; Chung, Wook Sung; Seung, Ki Bae; Park, Seung Jung.

In: American Heart Journal, Vol. 159, No. 4, 01.04.2010.

Research output: Contribution to journalArticle

Li, YJ, Rha, S-W, Chen, KY, Poddar, KL, Jin, Z, Minami, Y, Wang, L, Dang, Q, Li, GP, Ramasamy, S, Park, JY, Choi, CU, Kim, JW, Kim, EJ, Park, CG, Seo, HS, Oh, DJ, Jeong, MH, Ahn, YK, Hong, TJ, Park, JS, Kim, YJ, Hur, SH, Seong, IW, Chae, JK, Cho, MC, Bae, JH, Choi, DH, Jang, YS, Chae, IH, Kim, HS, Kim, CJ, Yoon, JH, Ahn, TH, Tahk, SJ, Chung, WS, Seung, KB & Park, SJ 2010, 'Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents', American Heart Journal, vol. 159, no. 4. https://doi.org/10.1016/j.ahj.2009.12.041
Li, Yong Jian ; Rha, Seung-Woon ; Chen, Kang Yin ; Poddar, Kanhaiya L. ; Jin, Zhe ; Minami, Yoshiyasu ; Wang, Lin ; Dang, Qun ; Li, Guang Ping ; Ramasamy, Sureshkumar ; Park, Ji Young ; Choi, Cheol Ung ; Kim, Jin Won ; Kim, Eung Ju ; Park, Chang Gyu ; Seo, Hong Seog ; Oh, Dong Joo ; Jeong, Myung Ho ; Ahn, Young Keun ; Hong, Taek Jong ; Park, Jong Seon ; Kim, Young Jo ; Hur, Seung Ho ; Seong, In Whan ; Chae, Jei Keon ; Cho, Myeong Chan ; Bae, Jang Ho ; Choi, Dong Hoon ; Jang, Yang Soo ; Chae, In Ho ; Kim, Hyo Soo ; Kim, Chong Jin ; Yoon, Jung Han ; Ahn, Tae Hoon ; Tahk, Seung Jea ; Chung, Wook Sung ; Seung, Ki Bae ; Park, Seung Jung. / Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents. In: American Heart Journal. 2010 ; Vol. 159, No. 4.
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abstract = "Background: Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. Methods: A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95{\%} CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95{\%} CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95{\%} CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex. Conclusions: The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.",
author = "Li, {Yong Jian} and Seung-Woon Rha and Chen, {Kang Yin} and Poddar, {Kanhaiya L.} and Zhe Jin and Yoshiyasu Minami and Lin Wang and Qun Dang and Li, {Guang Ping} and Sureshkumar Ramasamy and Park, {Ji Young} and Choi, {Cheol Ung} and Kim, {Jin Won} and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo} and Jeong, {Myung Ho} and Ahn, {Young Keun} and Hong, {Taek Jong} and Park, {Jong Seon} and Kim, {Young Jo} and Hur, {Seung Ho} and Seong, {In Whan} and Chae, {Jei Keon} and Cho, {Myeong Chan} and Bae, {Jang Ho} and Choi, {Dong Hoon} and Jang, {Yang Soo} and Chae, {In Ho} and Kim, {Hyo Soo} and Kim, {Chong Jin} and Yoon, {Jung Han} and Ahn, {Tae Hoon} and Tahk, {Seung Jea} and Chung, {Wook Sung} and Seung, {Ki Bae} and Park, {Seung Jung}",
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T1 - Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

AU - Li, Yong Jian

AU - Rha, Seung-Woon

AU - Chen, Kang Yin

AU - Poddar, Kanhaiya L.

AU - Jin, Zhe

AU - Minami, Yoshiyasu

AU - Wang, Lin

AU - Dang, Qun

AU - Li, Guang Ping

AU - Ramasamy, Sureshkumar

AU - Park, Ji Young

AU - Choi, Cheol Ung

AU - Kim, Jin Won

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

AU - Jeong, Myung Ho

AU - Ahn, Young Keun

AU - Hong, Taek Jong

AU - Park, Jong Seon

AU - Kim, Young Jo

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Chae, Jei Keon

AU - Cho, Myeong Chan

AU - Bae, Jang Ho

AU - Choi, Dong Hoon

AU - Jang, Yang Soo

AU - Chae, In Ho

AU - Kim, Hyo Soo

AU - Kim, Chong Jin

AU - Yoon, Jung Han

AU - Ahn, Tae Hoon

AU - Tahk, Seung Jea

AU - Chung, Wook Sung

AU - Seung, Ki Bae

AU - Park, Seung Jung

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Background: Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. Methods: A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex. Conclusions: The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.

AB - Background: Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. Methods: A total of 3,372 STEMI patients who underwent primary PCI with DESs received either LMWH (n = 1,531 patients, subcutaneous enoxaparin 1 mg/kg, bid for 3-5 days plus reduced dose of UFH [50 U/kg] during PCI) or UFH alone (n = 1,841 patients, intravenous bolus injection of 5,000 U, followed by 24,000 U/d infusion for at least 48 hours). The bleeding events and clinical outcomes during in-hospital and at 8 months were compared. Results: The incidences of major and minor bleeding events were similar between the 2 groups. Multivariable Cox regression analysis showed that LMWH group had lower incidences of cardiac death (adjusted odds ratio [OR] 0.55, 95% CI 0.39-0.77, P < .001), total death (adjusted OR 0.50, 95% CI 0.37-0.68, P < .001), and total major adverse cardiac events (adjusted OR 0.77, 95% CI 0.62-0.95, P = .017) at 8 months as compared with UFH group. Similar results were obtained across different subgroups including different DESs, age, and sex. Conclusions: The LMWH enoxaparin combined with reduced dose of UFH (50 U/kg) administration as an adjunctive antithrombotic therapy in STEMI patients undergoing primary PCI with DESs seems to be safe and efficacious. However, randomized clinical trials are needed to confirm this conclusion.

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