Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Low molecular weight heparin (dalteparin) compared to unfractionated heparin as an adjunct to rt-PA (alteplase) for improvement of coronary artery patency in acute myocardial infarction—the ASSENT Plus study
a Department of Medical Sciences, Cardiology, University Hospital, S-751 85 Uppsala, Sweden
b Department of Radiology, Danderyd's Hospital, Stockholm, Sweden
c Department of Cardiology, Sahlgrenska Hospital, Gothenburg, Sweden
d Pharmacia Corp., Stockholm, Sweden
e Duke Clinical Research Institute, Durham, NC, USA
f Department of Medical Sciences, Cardiology, University Hospital, S-751 85 Uppsala, Sweden
g Boehringer-Ingelheim, Stockholm, Sweden
h Department of Thoracic Radiology, Karolinska Hospital, Stockholm, Sweden
i Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
j Department of Clinical Chemistry, Uppsala, Sweden
k Department of Cardiology, University Hospital, Linkoping, Sweden
* Corresponding author. Tel.: +46-18-611-43-93; fax: +46-18-50-66-38
E-mail address: lars.wallentin{at}thorax.uas.lul.se
Received 9 October 2002; revised 10 December 2002; accepted 10 December 2002
Background Current thrombolytic–antithrombotic regimens in acute myocardialinfarction (AMI) are limited by incomplete early coronary reperfusion and by reocclusion and reinfarction. We compared the effects of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) as an adjunct to recombinant tissue-plasminogen activator (alteplase) on coronary artery patency and clinical outcomes in AMI.
Methods Patients with AMI treated with alteplase 
were randomised to either subcutaneous dalteparin (120IU/kg every 12h) for 4–7 days or intravenous infusion of UFH for 48h. Coronary angiography was performed between day 4 and hospital discharge. Clinical events and safety were evaluated until day 30.
Results Overall there were higher thrombolysis in myocardial infarction (TIMI) flows in the infarct related coronary artery in the dalteparin group 
. The predefined primary end-point, TIMI grade 3 flow, did not reach statistical significance (dalteparin 69.3% versus heparin 62.5%; 
). However, TIMI 0-1 flow (13.4 versus 24.4%; 
) and its combination with intraluminal thrombus (27.9 versus 42.0%;
) were less common in the dalteparin group. During the period of randomised treatment there were less myocardial reinfarctions in the dalteparin group
but after cessation of dalteparin there were more reinfarctions resulting in no difference in death or MI at 30 days. There were no significant differences in major bleeding or stroke after 30 days.
Conclusions In alteplase treated AMI adjunctive dalteparin for 4–7 days seems to reduce the risk of early coronary artery occlusion and reinfarction. However, early after cessation of treatment there is a raised risk of events, which might eliminate any long-term gains.
Key Words: Angiography • Coronary disease • Heparin • Myocardial infarction • Thrombolysis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. J. Quinlan and J. W. Eikelboom Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction Arch Intern Med, June 22, 2009; 169(12): 1163 - 1164. [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kempf, E. Bjorklund, S. Olofsson, B. Lindahl, T. Allhoff, T. Peter, J. Tongers, K. C. Wollert, and L. Wallentin Growth-differentiation factor-15 improves risk stratification in ST-segment elevation myocardial infarction Eur. Heart J., December 1, 2007; 28(23): 2858 - 2865. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Bjorklund, T Jernberg, P Johanson, P Venge, M Dellborg, L Wallentin, B Lindahl, and the ASSENT-2 and ASSENT-PLUS Study Groups Admission N-terminal pro-brain natriuretic peptide and its interaction with admission troponin T and ST segment resolution for early risk stratification in ST elevation myocardial infarction Heart, June 1, 2006; 92(6): 735 - 740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Sabatine, D. A. Morrow, G. Montalescot, M. Dellborg, J. L. Leiva-Pons, M. Keltai, S. A. Murphy, C. H. McCabe, C. M. Gibson, C. P. Cannon, et al. Angiographic and Clinical Outcomes in Patients Receiving Low-Molecular-Weight Heparin Versus Unfractionated Heparin in ST-Elevation Myocardial Infarction Treated With Fibrinolytics in the CLARITY-TIMI 28 Trial Circulation, December 20, 2005; 112(25): 3846 - 3854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Eikelboom, D. J. Quinlan, S. R. Mehta, A. G. Turpie, I. B. Menown, and S. Yusuf Unfractionated and Low-Molecular-Weight Heparin as Adjuncts to Thrombolysis in Aspirin-Treated Patients With ST-Elevation Acute Myocardial Infarction: A Meta-Analysis of the Randomized Trials Circulation, December 20, 2005; 112(25): 3855 - 3867. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
|
|
K. K. Ray, D. A. Morrow, C. M. Gibson, S. Murphy, E. M. Antman, E. Braunwald, and for the ENTIRE-TIMI 23 Study Group Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome: An ENTIRE-TIMI 23 substudy Eur. Heart J., March 1, 2005; 26(5): 440 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S Kalus and L. R Moser Evolving Role of Low-Molecular-Weight Heparins in ST-Elevation Myocardial Infarction Ann. Pharmacother., March 1, 2005; 39(3): 481 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman and F. Van de Werf Pharmacoinvasive Therapy: The Future of Treatment for ST-Elevation Myocardial Infarction Circulation, June 1, 2004; 109(21): 2480 - 2486. [Full Text] [PDF]
|
|
|
|
|
|
E. Bjorklund, B. Lindahl, P. Johanson, T. Jernberg, A.-M. Svensson, P. Venge, L. Wallentin, M. Dellborg, and the ASSENT-2 and ASSENT-PLUS study groups Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction Eur. Heart J., January 2, 2004; 25(2): 113 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 ASSENT Plus: Dalteparin vs. UFH as an Adjunct to rt-PA Journal Watch Emergency Medicine, July 15, 2003; 2003(715): 8 - 8. [Full Text]
|
|
|
|
|
|
L. Wallentin, P. Goldstein, P.W. Armstrong, C.B. Granger, A.A.J. Adgey, H.R. Arntz, K. Bogaerts, T. Danays, B. Lindahl, M. Makijarvi, et al. Efficacy and Safety of Tenecteplase in Combination With the Low-Molecular-Weight Heparin Enoxaparin or Unfractionated Heparin in the Prehospital Setting: The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS Randomized Trial in Acute Myocardial Infarction Circulation, July 15, 2003; 108(2): 135 - 142. [Abstract] [Full Text] [PDF]
|
|